Pharmacotherapy (excluding biotherapies) for ankylosing spondylitis: development of recommendations for clinical practice based on published evidence and expert opinion.
OBJECTIVE
To develop recommendations about pharmacotherapy (excluding biotherapeutic agents) in patients with axial forms of ankylosing spondylitis (AS) seen in everyday clinical practice.


METHODS
The recommendations were based on evidence from the literature. First, a scientific committee used a Delphi procedure to select five focal points about which recommendations were needed. Then, a literature task force looked for relevant publications in the following: Cochrane, PubMed, and Ovid databases; and abstracts from the French Society for Rheumatology, European League against Rheumatism, and American College of Rheumatology. Based on the data in these publications, recommendations were drafted then validated by a group of experts. The strength of each recommendation was determined, as well as the extent of agreement among the experts.


RESULTS
The four focal points were the best strategy for using nonsteroidal anti-inflammatory drugs, role for systemic glucocorticoid therapy, role for glucocorticoid injections into the sacroiliac joints and entheses, and role for slow-acting drugs (e.g., methotrexate, sulfasalazine, leflunomide, thalidomide, and pamidronate). Of the 661 promising publications identified by the literature search, 173 were found to be relevant. The evidence in these 173 papers was reported to experts during interactive workshops. At the end of the workshops, the experts drafted recommendations, which were then validated by having all panel participants vote during a final meeting. There were seven recommendations, whose strength ranged from A to D.


CONCLUSIONS
Seven recommendations about pharmacotherapy in patients with AS were developed. They can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of patients with AS in France.
Lavie
Frédéric
F
Service de Rhumatologie, Hôpital de Bicêtre, Le Kremlin Bicêtre, France.
Pavy
Stephan
S
Dernis
Emmanuelle
E
Goupille
Philippe
P
Cantagrel
Alain
A
Tebib
Jacques
J
Claudepierre
Pascal
P
Flipo
René Marc
RM
Le Loët
Xavier
X
Maillefert
Jean-Francis
JF
Mariette
Xavier
X
Saraux
Alain
A
Schaeverbeke
Thierry
T
Wendling
Daniel
D
Combe
Bernard
B
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D032921:Consensus; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal