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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;


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.

  • ASAS Working Group
  • ankylosing spondylitis
  • tumour necrosis factor α
  • consensus statement, infliximab
  • etanercept
  • adalimumab
  • AS, ankylosing spondylitis
  • ASAS, ASsessments in AS
  • BASDAI, Bath AS Disease Activity Index
  • BASFI, Bath AS Functional Index
  • CRP, C reactive protein
  • DC-ART, disease controlling antirheumatic treatment
  • DMARDs, disease modifying antirheumatic drugs
  • ESR, erythrocyte sedimentation rate
  • MRI, magnetic resonance imaging
  • NRS, numerical rating scale
  • NSAIDs, non-steroidal anti-inflammatory drugs
  • RA, rheumatoid arthritis
  • SpA, spondyloarthritides
  • TNFα, tumour necrosis factor α
  • VAS, visual analogue scale

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