medwireNews: The Assessment of SpondyloArthritis international Society (ASAS) and EULAR have issued up-to-date guidance on the management of radiographic and nonradiographic axial spondyloarthritis (axSpA).
“It is our vision that these recommendations standardise and optimise the treatment of people living with axSpA, contributing to both individual well-being as well as wider societal benefit through better management of the disease,” Sofia Ramiro (Leiden University Medical Center, the Netherlands) colleagues write in the Annals of the Rheumatic Diseases.
Outlining the need for the latest update, the authors say that “[t]he armamentarium of pharmacological options for axSpA has expanded significantly in recent years.” For instance, “[m]ore data on secukinumab as well as on ixekizumab can now be considered,” and Janus kinase (JAK) inhibitors “represent a completely new drug class in these recommendations,” they add.
The updated recommendations comprise five overarching principles and 15 recommendations, with a focus on individualized medicine. Ramiro and team point to the “seemingly similar” efficacy of different drugs and “lack of relevant head-to-head trials to date,” meaning that “there are no reasons for prioritising one or the other in terms of efficacy.”
Therefore, they introduce a new treatment recommendation based on extramusculoskeletal manifestations, namely that tumor necrosis factor inhibitors are preferred in patients with a history of recurrent uveitis or active inflammatory bowel disease, whereas interleukin-17A inhibitors (IL-17i) are recommended in people with significant psoriasis.
“The latter aligns with the EULAR recommendations for [psoriatic arthritis], also giving preference to an IL-17i in case of significant skin involvement,” say the authors.
They note that “caution is advised” regarding JAK inhibitor use “[u]ntil more solid [safety] data are available in axSpA.”
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Ann Rheum Dis 2022; doi:10.1136/ard-2022-223296