Pavelka K. and the Committee of the Czech Society for Rheumatology. Recommendations of the Czech Society for Rheumatology the Pharmacological Treatment of Axial Spondyloarthritis Part I. Treatment and pharmacotherapy strategies

Czech version

Authors: K. Pavelka; Výbor České Revmatologické Společnosti
Authors‘ workplace: Revmatologický ústav Praha
Published in: Čes. Revmatol., 29, 2021, No. 1, p. 5-19.
Category: Recomendation

Overview

The recommendations of the Czech Society for Rheumatology (ČRS) for the treatment of ankylosing spondylitis (AS) were published in 2012, and, therefore, the decision of the ČRS committee proceeded to the innovation of these criteria. It was based on the ASAS / EULAR recommendations for the treatment of axial spondyloarthritis, published in 2017, which are based on published records and the consensus of leading experts. Compared to the older criteria, there are several important innovations. The first and fundamental difference is the fact that these recommendations already apply to patients with a wider range of axial spondyloarthritis (SpA), i.e., radiographic and non-radiographic SpA and not just ankylosing spondylitis. There is also some innovation in views on the evaluation of disease activity so that the ASDAS score is now preferred. The intentions of this score also define a threshold for the initiation of biologic therapy (ASDAS ≥ 2.1) and more specifically defined treatment targets. Another new element is the introduction of newer drugs, i.e., IL-17 inhibitors. The current recommendations list IL-17 inhibitors as an alternative to first-line treatment with TNF inhibitors. These recommendations also include instructions on how to proceed in patients with extra-articular symptoms, i.e., acute anterior uveitis, idiopathic inflammatory bowel disease, and osteoporosis.

Keywords:

axial spondyloarthritis – biological treatment – disease activity – recommended procedures

Sources

1. Rudwaleit M, van der Heide D, Landewe R. Development of ASAS classification criteria for axial spondyloarthritis (part II): validation and final section. Ann Rheum Dis 2009; 68: 777–783.

2. Sieper J, van der Heijde D. Review non-radiographic axial spondyloarthritis new definition of old disease? Arthritis Rheum 2013; 65: 543–551.

3. van der Heide D, Ramiro S, Landewe R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis 2017; 76: 978–991.

4. van der Heide D, Joshi A, Pangan AL. ASAS 40 and ASDAS clinical trial translate to meaningful improvements in physical function health related quality of life and work productivity in patients with non-radiographic axial spondyloarthritis. Rheumatology (Oxford) 2016; 55: 80–88.

5. Landewé R, Strand V, van der Heijde D. From inhibition of radiographic progression to maintaining structural integrity: a methodological framework for radiographic progression in rheumatoid arthritis and psoriatic arthritis clinical trial. Ann Rheum Dis 2013; 72(7): 1113–1117.

6. Deodhar A, van der Heijde D, Gensler LS, Kim TH, Maksymowych WP, Østergaard M, Poddubnyy D, et al. Ixekizumab for patients with non–radiographic axial spondyloarthritis (COAST–X): a randomised, placebo–controlled trial. COAST–X Study Group. Lancet 2020; 395(10217): 53–64.

7. Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of Spondyloarthritis International Society (ASAS) handbook a guide to asses spondyloarthritis. Ann Rheum Dis 2009; 68(Suppl 2): ii–44.

8. Garret S, Jenkinson T, Kennedy LG, et al. A new approach to define disease activity in ankylosing spondylitis: the Bath Ankylosing Spondylitis Diasease Activity Index. J Rheumatol 1994; 21: 286–291.

9. Machado PM, Lamdewe R, van der Heide D. Assessment of ASAS. Ankylosing Spondylitis Disease Activity Score (ASDAS). 2018 update of the nomenclature fir disease activity states. Ann Rheum Dis 2018; 77: 1539–1540.

10. Jenkinson TR, Mallorie PA, Whitelock HC, et al. Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 1994; 21: 1694–811.

11. Calin A, Garret S, Whitelock H, et al. A new approach to defining functional ability in AS the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 1994; 21: 1281–1285.

12. Mease PJ, van der Bosch F, Sieper J, et al. Performance of 3 enthesitis indices in patients with peripheral spondyloarthritis during treatment with adalimumab. J Rheumatol 2017; 44: 599–608.13. Landewe R, Tubergen A. Clinical tools to asses and monitor spondyloarthritis. Curr Rheumatol Rep 2015; 17: 47.

14. Navarro-Compan V, Ramiro S, Landewe R, et al. Disease activity is longitudinally related to sacroiliac inflammation on MR in male patients with axial spondyloarthritis. 2 years of the DESIR cohort. Ann Rheum Dis 2016; 75: 854–858.

15. Poddubnyy D, Listing J, Haibel H, et al. Functional relevance of radiographic spinal progression in axial spondyloarthritis: results from German Spondyloarthritis Inception Cohort. Rheumatology 2018; 57: 703–711.

16. Ramiro S, Stoljwijk C, van Tubergen A, et al. Evolution of radiographic damage in ankylosing spondylitis: A 12 year prospective follow-up of the OASIS study. Ann Rheum Dis 2015; 74: 52–59.

17. Smolen J, Schols M, Barun J, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis especially psoriatic arthritis to target.2017 update of recommendations by international task force. Ann Rheum Dis 2018; 77: 3–17.

18. Kroon F, Landewe R, Dougados M et al. Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis. Ann Rheum Dis 2012; 71: 1623–1629.

19. Sieper J, Listing J, Poddubnyy D, et al. Effect of continuous versus on demand treatment of ankylosing spondylitis with diclofenac over 2 years on radiographic progression of the spine” results from a randomised multicentre trial (ENRADAS). Ann Rheum Dis 2016; 75: 1438–1443.

20. Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the American College of Rheumatology / Spondylitis Association of America/ Spondylarthritis Research and Treatment Network Recommendations for the treatment of ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis Arthritis Rheumatol 2019; 71: 1599–1613.

21. Dougados M. Treat to target in axial spondyloarthritis: from its concept to its implementation. Journal of Autoimmunity https://doi.org/1016/j.aut.2019.102398

22. Chen J, Liu C. Sulfasalazine for ankylosing spondylitis. Cochrane Database Syst Rev 2005; (2) CD0004800.

23. Dougados M, van der Linden S, Leirisalo-Repo M. Sulfasalazin in the treatment of spondyloarthropathy. A randomized, multicentre study. Arthritis Rheum 1995; 38: 618–627.

24. Haibel H, Brandt HC, Song IH, et al. No efficacy of subcutaneous methotrexate in active ankylosing spondylitis: a 16 week, open label trial. Ann Rheum Dis 2007; 66: 419–421.

25. Machado P, Landewe RBM, Braun J, et al. MR inflammation and its relation with measures of clinical activity and different treatment responses in patients with ankylosing spondylitis treated with a tumour necrosis factor inhibitor. Ann Rheum Dis 2012; 71: 2002–2005.

26. Navarro-Compan V, Ramiro S, Landewe R, et al. Disease activity is longitudinally related to sacroiliac inflammation on MRI in male patients with axial spondyloarthritis: 2 years of the DESIR cohort. Ann Rheum Dis 2016; 5: 874–878.

27. Protopopov M, Sieper J, Haibel J, et al. Relevance of structural damage in the sacroiliac joints with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort Arthritis Res Ther 2017; 19(1): 240.

28. van der Heijde D, Dijkmans B, Geusens P, et al. Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT). Arthritis Rheum 2005; 52: 582–591.

29. Sieper J, van der Heide D, Dougados M. Efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis results of a randomised, placebo controlled trial (ABILITY-1). Ann Rheum Dis 2013; 72: 815–822.

30. Braun J, van der Horst-Bruinsma IE, Huang F, et al. Clinical efficacy and safety of etanercept versus sulfasalazine in ankylosing spondylitis patients: a randomized double blind trial. Arthritis Rheum 2011; 63(6): 1543–1551.

31. Landewé R, Braun J, Deodhar A, et al. Efficacy of certolizumab pegol on signs and symptoms of axial spondyloarthritis including ankylosing spondylitis: 24-week results of a double-blind randomised placebo-controlled Phase 3 study. Ann Rheum Dis 2014; 73(1): 39–47.

32. Inman RD, Davis JC Jr, Heijde DV, et al. Efficacy and safety of golimumab in patients with ankylosing spondylitis: results of a randomized, double-blind, placebo-controlled, phase III trial. Arthritis Rheum 2008; 58: 3402–3412.

33. Marona J, Sepriano A, Rodrigues-Manica S, et al. Eligibility for biologic disease-modifying antirheumatic drugs in axial spondyloarthritis: going beyond BASDAI. RMD Open 2020; 6: e001145.

34. Braun J, Baraliakos X, Deodhar A, Baeten D, Sieper J, Emery P, et al. Effect of secukinumab on clinical and radiographic outcomes in ankylosing spondylitis: 2-year results from the randomised phase III MEASURE 1 study. Ann Rheum Dis 2017; 76(6): 1070–1077.

35. Sieper J, Deodhar A, Marzo-Ortega H, Aelion JA, Blanco R, Jui-Cheng T, et al. Secukinumab efficacy in anti-TNF-naive and anti-TNF-experienced subjects with active ankylosing spondylitis: results from the MEASURE 2 Study. Ann Rheum Dis 2017; 76(3): 571–592.

36. Deodhar A, Poddubnyy D, Pacheco-Tena C, et al. Efficacy and safety of ixekizumab in the treatment of radiographic axial spondyloarthritis: sixteen-week results from a phase III randomized, double-blind, placebo-controlled trial in patients with prior inadequate response to or intolerance of tumor necrosis factor inhibitors. Arthritis Rheum 2019; 71: 599–611.

37. Lie E, van der Heide D, Uhlig T, et al. Effectiveness of switching between TNF inhibitors in ankylosing spondylitis: data from nor DMARD register. Ann Rheum Dis 2011; 70: 157–163.

38. Deodhar A, Gensler LS, Kay J, et al. A fifty – two week, randomized, placebo-controlled trial of certolizumab pegol in non--radiographic axial spondyloarthritis. Arthritis Rheumatology 2019; 71(7): 1101–1111.

39. Deodhar A, Blanco R, Dokoupilová E, et al. Improvement of signs and symptoms of nonradiographic axial spondyloarthritis in patients Ttreated with secukinumab: primary results of a randomized, placebo-controlled phase III study. Arthritis Rheumatol 2020;73(1): 110–120.

40. Baeten D, Sieper J, Braun J, et al. Secukinumab, an interleukin-17 inhibitor in ankylosing spondylitis. N Engl J Med 2015; 373: 2534–2548.

41. Pavelka K, Kivitz AJ, Dokoupilová E, et al. Secukinumab 150/300 mg provides sustained improvements in the signs and symptoms of active ankylosing spondylitis: 3-year results from the phase 3 MEASURE 3 Study. ACR Open Rheumatol 2020; 2(2): 119–117.

42. Micheroli R, Tellenbach CH, Scherer A, et al. Effectiveness of secukinumab versus an alternative TNF inhibitor in patients with axial spondyloarthritis previously exposed to TNF inhibitor in the Swiss Clinical Quality Management cohort. Ann Rheum Dis 2020; 79: 1203–1209.

43. Landewe R, Sieper J, Mease P, et al. Efficacy And safety of continuing versus withdrawing adalimumab therapy in maintaining remission in patients with non.– radiographic axial spondyloarthritis (ABILITY-3) a multicentre, randomised, double blind study. Lancet 2018; 392 (10142): 134–144.

44. Závada J, Uher M, Sisol K, et al. A tailored approach to reduce dose of anti-TNF drugs may be equally effective, but substantially less costly than standard dosing in patients with ankylosing spondylitis over 1 year: a propensity score – matched cohort study. Ann Rheum Dis 2016; 75: 96–102.

45. Landewe R, van der Heide D, Dougados M, et al. Maintained of clinical remission in early axial spondyloarthritis following certolizumab pegol dose reduction. Ann Rheum Dis 2020; 79: 920–928.

46. Wendling D, Joshi A, Reilly P, Jalundhwala YJ, Mittal M, Bao Y. Comparing the risk of developing uveitis in patients initiating anti-tumor necrosis factor therapy for ankylosing spondylitis: an analysis of a large US claims database. Curr Med Res Opin 2014; 30(12): 2515–2521.

47. Lie E, Lindstrom U, Zverkova-Sandstrom T, et al. Tumour necrosis factor inhibitor treatment and occurrence of anterior uveitis in ankylosing spondylitis: results from the Swedish biologics register. Ann Rheum Dis 2017; 76(9): 1515–1521.

48. Chimanti MS, Conigliari P, Trigianese P, et al. Use of synthetic and biological DMARD in patients with enteropathy spondyloarthritis: a combined gastro-rheumatological approach. Clin Exp Rheum 2019; 37: 723–730.

49. Sandborn W, Stenson W, Brynskow J, et al. Safety of celekoxib in patients with ulcerative colitis in remission: a randomised, placebo controlled pilot. Clin Gastroenterol Hepatol 2006; 4: 829–838.

50. Olivieri I, Cantini F, Castiglione F, et al. Italian Expert Panel on the management of patients with coexisting spondyloarthritis and inflammatory bowel disease. Autoimmunity Rev 2014; 13: 822–830.

51. Sepriano A, Regel A, van der Heide D, et al. Efficacy and safety of biological and targeted synthetic literature review informing the 2016 update of the ASAS/EULAR recommendations for the management of axial spondyloarthritis. RMD Open 3; e000396.

52. Thomas T, Casado E, Geusens P, Lems WF, Timoshanko J, Taylor D, Hofbauer LC. Is a treat-to-target strategy in osteoporosis applicable in clinical practice? Consensus among a panel of European experts. Osteoporos Int 2020; 31(12): 2303–2311.

53. Pray C, Feroz NI, Nigil Haroon N. Bone mineral density and fracture risk in ankylosing spondylitis: a meta-analysis. Calcif Tissue Int 2017; 101(2): 182–192.

Labels

Dermatology & STDs Paediatric rheumatology Rheumatology

ÚVODNÍK

The fate of a knee after partial meniscectomy: a review of radiological and clinical outcomes with at least 5-year follow-up

Validation of Czech versions of questionnaires assessing female sexual function and pelvic floor function

Ukazatele aktivity a funkčního postižení u revmatoidní artritidy

Risks of long-term bisphosphonate treatment

Article was published in

Czech Rheumatology

2021 Issue 1