Portuguese recommendations for the use of biological therapies in patients with axial spondyloarthritis - 2016 update

P.M. Machado, M. Cerqueira, P. Ávila-Ribeiro, R. Aguiar, A. Bernardo, A. Sepriano, A. Águeda, A. Cordeiro, A. Raposo, A.M. Rodrigues, A. Barcelos, A. Malcata, C. Lopes, C.C. Vaz, D. Nour, F. Godinho, F. Alvarenga, F. Pimentel-Santos, H. Canhão, H. SantosI. Cunha, J.S. Neves, J.E. Fonseca, J.L. Gomes, J. Tavares-Costa, L. Costa, L. Cunha-Miranda, L. Maurício, M. Cruz, M.C. Afonso, M.J. Santos, M. Bernardes, P. Valente, R. Figueira, S. Pimenta, S. Ramiro, T. Pedrosa, T.A. Costa, E. Vieira-Sousa

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Objective: To update the recommendations for the treatment of axial spondyloarthritis (axSpA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on lite - rature evidence and consensus opinion. At a national meeting, the recommendations included in this document were discussed and updated. A draft of the full text of the recommendations was then circulated and suggestions were incorporated. A final version was again circulated before publication and the level of agreement among Portuguese Rheumatologists was anonymously assessed using an online survey. Results: A consensus was achieved regarding the initiation, assessment of response and switching of biological therapies in patients with axSpA. In total, seven recommendations were produced. The first recommendation is a general statement indicating that biological therapy is not a first-line drug treatment option and should only be used after conventional treatment has failed. The second recommendation is also a ge - neral statement about the broad concept of axSpA adopted by these recommendations that includes both non-radiographic and radiographic axSpA. Recommendations 3 to 7 deal with the definition of active di - sease (including the recommended threshold of 2.1 for the Ankylosing Spondylitis Disease Activity Score [ASDAS] or the threshold of 4 [0-10 scale] for the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), conventional treatment failure (nonsteroidal anti-inflammatory drugs being the first-line drug treatment), assessment of response to treatment (based on an ASDAS improvement of at least 1.1 units or a BASDAI improvement of at least 2 units [0-10 scale] or at least 50%), and strategy in the presence of an ina - dequate response (where switching is recommended) or in the presence of long-term remission (where a process of biological therapy optimization can be consi - dered, either a gradual increase in the interval between doses or a decrease of each dose of the biological the - rapy). Conclusion: These recommendations may be used for guidance in deciding which patients with axSpA should be treated with biological therapies. They co - ver a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.
Original languageEnglish
Pages (from-to)209-218
Number of pages10
JournalActa Reumatológica Portuguesa
Issue number3
Publication statusPublished - Jul 2017


  • Ankylo - sing spondylitis
  • Axial spondyloarthritis
  • Biological therapies
  • Guidelines
  • Portugal
  • Recommendations


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