2018 APLAR axial spondyloarthritis treatment recommendations

Tam, Lai‐Shan; Wei, James Cheng‐Chung; Aggarwal, Amita; Baek, Han Joo; Cheung, Peter; Chiowchanwisawakit, Praveena; Dans, Leonila F.; J, Gu; Hagino, Noboru; Kishimoto, Mitsumasa; Reyes, Heizel Manapat; Soroosh, Soosan; Stebbings, Simon; Whittle, Samuel L; Yeap, Swan Sim; Lau, Chak Sing

doi:10.1111/1756-185x.13510

Cited by 61 publications

(73 citation statements)

References 175 publications

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“…The updated consensus statements were crafted to take account of recent understanding of the disease and newer therapeutic options. Similar to the recently published Asia‐Pacific League of Associations for Rheumatology recommendations, the goal is to provide guidance relevant to the Asia‐Pacific region . As newer evidence will continue to emerge, exercises to update the consensus statements will continue to be periodically performed.…”

Section: Discussionmentioning

confidence: 99%

Update on recommendations for eligibility of government subsidization of biologic disease‐modifying antirheumatic drugs for the treatment of axial spondyloarthritis in Singapore

et al. 2019

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Aims The field of axial spondyloarthritis (axSpA) has undergone significant changes recently in particular with disease classification, assessment of disease activity and increased treatment options for biologics. In order to reflect these developments, we aimed to update the local consensus recommendations for subsidization of biologics. Methods A modified Delphi approach was used. Six published guidelines from major rheumatology societies and healthcare authorities on axSpA were reviewed. Findings were synthesized and used in formulating updated recommendation statements. Recommendations were rated by 10 practicing rheumatologists in Singapore. Consensus was reached if there was more than 70% agreement or disagreement. Results Ten statements achieved consensus. Patients may be considered for subsidization of biologic therapy if they fulfill the Assessment of Spondyloarthritis International Society or modified New York criteria, with persistently active disease (defined either by Ankylosing Spondylitis Disease Activity Score ≥ 2.1 or Bath Spondylitis Disease Activity Index ≥ 4), despite 4 weeks of full‐dose non‐steroidal anti‐inflammatory drugs and regular exercise. Either tumor necrosis factor inhibitors or interleukin 17 inhibitors may be used as first‐line therapy, and should be continued if adequate response is achieved at 6 months. Conclusion Recommendation statements were formulated through a formal consensus process by local experts with a view to assist relevant authorities in funding considerations and for use in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Update on recommendations for eligibility of government subsidization of biologic disease‐modifying antirheumatic drugs for the treatment of axial spondyloarthritis in Singapore

et al. 2019

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“…Smoking may decrease the therapeutic responsiveness of DMARDs, such as antimalarial agents [77,78]. As patients with SRD also have a high risk of cardiovascular disease, smoking cessation is generally recommended by international societies [36,61,79].…”

Section: Recommendations Recommendation 1 Regular Exercise Within Thmentioning

confidence: 99%

Recommendations for the Management of Patients With Systemic Rheumatic Diseases During the Coronavirus Disease Pandemic

et al. 2020

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Patients with systemic rheumatic diseases (SRD) are vulnerable for coronavirus disease (COVID-19). The Korean College of Rheumatology recognized the urgent need to develop recommendations for rheumatologists and other physicians to manage patients with SRD during the COVID-19 pandemic. The working group was organized and was responsible for selecting key health questions, searching and reviewing the available literature, and formulating statements. The appropriateness of the statements was evaluated by voting panels using the modified Delphi method. Four general principles and thirteen individual recommendations were finalized through expert consensus based on the available evidence. The recommendations included preventive measures against COVID-19, medicinal treatment for stable or active SRD patients without COVID-19, medicinal treatment for SRD patients with COVID-19, and patient evaluation and monitoring. Medicinal treatments were categorized according to the status with respect to both COVID-19 and SRD. These recommendations should serve as a reference for individualized treatment for patients with SRD. As new evidence is emerging, an immediate update will be required.

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“…mg/kg, can significantly reduce the risk of tuberculosis reactivation, in guidelines published in this very journal 10. We feel that this issue could have been discussed in these guidelines 1. In this context,…”

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confidence: 94%

“…We read the recently published guidelines from the Asia-Pacific League of Associations for Rheumatology (APLAR) for the management of axial spondyloarthritis (AxSpA) with great expectation. 1 The Asia-Pacific region is home to nearly 2/3 of the world's population, and many countries of this region have cost-constrained healthcare settings, with significant out-of-pocket health expenditure. The burden of infectious diseases, including tuberculosis, is another overarching concern in this region.…”

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confidence: 99%

“…In this respect, with already existing treatment guidelines on AxSpA from the Assessment of Spondyloarthritis International Society -European League against Rheumatism (ASAS-EULAR), 3 there exists a degree of redundancy for the APLAR guidelines. 1 As an example, we shall discuss some published literature from India, an APLAR member, which refers to treatment strategies for AxSpA that could be relevant in a low-cost scenario. Two studies from south India 6 Two studies from Indian reported significant benefits of monthly pamidronate 60 mg for 6 months in refractory AxSpA, over and above NSAIDs.…”

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Comment on: 2018 APLAR axial spondyloarthritis treatment recommendations – Need for greater cognizance of regional needs?

et al. 2019

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We read the recently published guidelines from the Asia-Pacific League of Associations for Rheumatology (APLAR) for the management of axial spondyloarthritis (AxSpA) with great expectation. 1 The Asia-Pacific region is home to nearly 2/3 of the world's population, and many countries of this region have cost-constrained healthcare settings, with significant out-of-pocket health expenditure. The burden of infectious diseases, including tuberculosis, is another overarching concern in this region. The authors of this letter practice in a similarly constrained healthcare setting; therefore, we would like to express our concerns regarding the aforementioned guidelines.First, we felt the literature search in forming the APLAR AxSpA guidelines 1 to be inadequate. In our opinion, the authors should have also searched Scopus and the Web of Science, since these databases have greater breadth of coverage than Pubmed (Medline) or Embase, including non-anglophonic publications. 2 Furthermore, a handsearching of conference abstracts, to identify unpublished abstracts, should also have been conducted, supplemented with a search of clinical trials databases to identify ongoing or unpublished studies. We feel that this is particularly relevant in Asian settings, since concerns about English language may delay or even prevent publication of valuable scientific information from these areas. Furthermore, while the authors have used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to evaluate the quality of evidence presented, we could not find anywhere in the manuscript 1 detailed summary-of-findings tables generated using GRADE, which would have enhanced the understanding of these recommendations for the reader.We found a paucity of Asia-Pacific literature that was analyzed while formulating the guideline. We agree that there may not be many randomized controlled trials on this subject from these areas.

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2018 APLAR axial spondyloarthritis treatment recommendations

Cited by 61 publications

References 175 publications

Update on recommendations for eligibility of government subsidization of biologic disease‐modifying antirheumatic drugs for the treatment of axial spondyloarthritis in Singapore

Update on recommendations for eligibility of government subsidization of biologic disease‐modifying antirheumatic drugs for the treatment of axial spondyloarthritis in Singapore

Recommendations for the Management of Patients With Systemic Rheumatic Diseases During the Coronavirus Disease Pandemic

Comment on: 2018 APLAR axial spondyloarthritis treatment recommendations – Need for greater cognizance of regional needs?

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