title: Initiation of biological agents in patients with ankylosing spondylitis: results of a Delphi study by the ASAS Group.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: René Descartes University, Ap-HP, Rheumatology B Department, Cochin Hospital, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Pham
authors.forename: D
authors.initials: D
authors.lastname: van der Heijde
authors.forename: A
authors.initials: A
authors.lastname: Calin
authors.forename: M A
authors.initials: MA
authors.lastname: Khan
authors.forename: Sj
authors.initials: S
authors.lastname: van der Linden
authors.forename: N
authors.initials: N
authors.lastname: Bellamy
authors.forename: M
authors.initials: M
authors.lastname: Dougados
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D003697:Delphi Technique; D006305:Health Status Indicators; D006801:Humans; D018579:Patient Selection; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha