This paper presents the second update of the Assessment in SpondyloArthritis international Society (ASAS) consensus statement on the use of anti-tumour necrosis factor (anti-TNF) agents in patients with axial spondyloarthritis (SpA). A major change from the previous recommendations is that patients fulfilling the ASAS axial SpA criteria, which also include patients fulfilling the modified New York criteria for ankylosing spondylitis, can be treated with anti-TNF agents. This makes an earlier start in the disease process possible. A second major change is the mandatory pretreatment before anti-TNF agents can be started. All patients should have tried a minimum of two non-steroidal anti-inflammatory drugs for a minimum of 4 weeks in total. This is significantly shorter than the previous requirement of 3 months. As previously, patients with axial symptoms require no further pretreatment. Patients with symptomatic peripheral symptoms should normally have had an adequate therapeutic trial of a disease-modifying antirheumatic drug, preferably sulfasalazine. Sulfasalazine is no longer mandatory in this group of patients. Finally, efficacy should be evaluated after at least 12 weeks. The remaining recommendations stayed largely unchanged.
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Funding Wyeth financially supported the mailing of the questionnaire, without influence on the content and without access to the responses of the rheumatologists. All other costs were covered by ASAS.
Competing interests DvdH has received honoraria from Abbott, Amgen, AstraZeneca, BMS, Centocor, Chugai, Eli-Lilly, GSK, Merck, Novartis, Otsuka, Pfizer, Roche, Sanofi-Aventis, Schering-Plough, UCB, Wyeth; JS has received honoraria and research support from Abbott, Merck, Centocor, Pfizer, UCB; MD has received consultancy fees and research grants from Pfizer,Abbott, Sanofi-Aventis, BMS, UCB; RB has received honoraria from Abbott, BMS, Merck, Pfizer, Roche; WM Abbott, Centocor, Pfizer, Schering-Plough, Wyeth; RL has received honoraria from Amgen, Abbott, Centocor, Celltech, Glaxo-Smith-Kline, Merck (incl Schering-Plough), Pfizer (incl Wyeth), UCB; MR has received honoraria from Abbott, Centocor, BMS, MSD, Pfizer, Roche, UCB; JB has received honoraria and grants from Abbott, Amgen, BMS, Celgene, Celltrion, Centocor, MSD (Schering-Plough), Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis and UCB.
Provenance and peer review Not commissioned; externally peer reviewed.