Initiation of biological agents in patients with ankylosing spondylitis: results of a Delphi study by the ASAS Group.
BACKGROUND: There is ample evidence of important symptomatic efficacy of tumour necrosis factor alpha (TNFalpha) inhibition in ankylosing spondylitis (AS). Moreover, studies suggest that anti-TNF could be considered as the first disease controlling antirheumatic treatment (DC-ART) for AS. OBJECTIVE: To determine precisely which patients with AS are most likely to benefit from anti-TNFalpha treatment because of the cost and possible long term side effects of such treatment. METHODS: Assessment in Ankylosing Spondylitis (ASAS) members were asked to use a Delphi technique to name the characteristics of patients with AS for whom they would start DC-ART, in three different clinical presentations (isolated axial involvement, peripheral arthritis, enthesitis). RESULTS: Among the 62 invited ASAS members, more than 50% actively participated in the four phases of definition according to the Delphi technique. For each of the three clinical presentations, a combination of five to six domains was proposed, with an evaluation instrument and a cut off point defining a minimum level of activity for each domain. CONCLUSION: This study provides a profile for a patient with AS for considering initiation of biological agents that reflects the opinion of the ASAS members, using a Delphi exercise. Further studies are required to assess their relevance and their consistency with clinical practice.[1]References
- Initiation of biological agents in patients with ankylosing spondylitis: results of a Delphi study by the ASAS Group. Pham, T., van der Heijde, D., Calin, A., Khan, M.A., van der Linden, S., Bellamy, N., Dougados, M. Ann. Rheum. Dis. (2003) [Pubmed]
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