rss
Ann Rheum Dis 2003;62:817-824 doi:10.1136/ard.62.9.817
  • Extended report

International ASAS consensus statement for the use of anti-tumour necrosis factor agents in patients with ankylosing spondylitis

  1. J Braun1,2,
  2. T Pham3,
  3. J Sieper2,4,
  4. J Davis5,
  5. Sj van der Linden6,
  6. M Dougados7,
  7. D van der Heijde8,
  8. for the ASAS Working Group
  1. 1Rheumazentrum Ruhrgebiet, Herne, Germany
  2. 2Medical Department I, Rheumatology, Benjamin Franklin Hospital, Free University Berlin, Germany
  3. 3Department of Rheumatology, Conception Hospital, AP-HM, Marseille, France
  4. 4German Rheumatism Research Centre Berlin, Germany
  5. 5Division of Rheumatology, University of California San Francisco, San Francisco, USA
  6. 6Department of Internal Medicine, Division of Rheumatology, University of Maastricht, The Netherlands
  7. 7Department of Rheumatology, Hôpital Cochin, University of Paris, France
  8. 8Department of Rheumatology, University Hospital, Maastricht, The Netherlands
  1. Correspondence to:
    Professor J Braun, Rheumazentrum Ruhrgebiet, Landgrafenstr 15, 44652 Herne, Germany;
    J.Braun{at}rheumazentrum-ruhrgebiet.de
  • Accepted 27 May 2003

Abstract

Objective: To obtain an international consensus about the use of anti-tumour necrosis factor α (anti-TNFα) for treating patients with ankylosing spondylitis (AS).

Methods: These recommendations were developed by a review of published reports in combination with expert opinion, including a Delphi exercise, and a consensus meeting of the ASsessments in AS (ASAS) Working Group.

Results: The final consensus comprises the following requirements: (1) For the initiation of anti-TNFα therapy: (a) a diagnosis of definitive AS; (b) presence of active disease for at least four weeks as defined by both a sustained Bath AS Disease Activity Index (BASDAI) of at least 4 and an expert opinion based on clinical features, acute phase reactants, and imaging modalities; (c) presence of refractory disease defined by failure of at least two non-steroidal anti-inflammatory drugs during a single three month period, failure of intra-articular steroids if indicated, and failure of sulfasalazine in patients with peripheral arthritis; (d) application and implementation of the usual precautions and contraindications for biological therapy. (2) For the monitoring of anti-TNFα therapy: both the BASDAI and the ASAS core set for clinical practice should be followed regularly. (3) For the discontinuation of anti-TNFα therapy: in non-responders, consideration should be made after 6–12 weeks’ treatment. Response is defined as improvement of (a) at least 50% or 2 units (on a 0–10 scale) of the BASDAI, (b) expert opinion that treatment should be continued.

Conclusion: This consensus statement on anti-TNFα treatment in AS may be used for guidance in clinical decision making and as the basis for the development of guidelines. Evaluation of the healthcare consequences of this consensus is subject to further research by the ASAS group.

Footnotes

    This Article

    1. Abstract
    2. Full text
    3. PDF

    Responses

    1. Submit a response
    2. No responses published

    Register for free content

    The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

    Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.