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.


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.
Pham
T
T
René Descartes University, Ap-HP, Rheumatology B Department, Cochin Hospital, Paris, France.
van der Heijde
D
D
Calin
A
A
Khan
M A
MA
van der Linden
Sj
S
Bellamy
N
N
Dougados
M
M
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
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha