This protocol is for patients with ankylosing spondylitis who have completed an adequate trial of a first biologic or targeted synthetic DMARD and have not achieved a meaningful reduction in disease activity.

Failure condition — why this protocol applies

The prior treatment — a TNFi or IL-17A inhibitor (or, in some cases, a Janus kinase inhibitor) — did not produce clinically important improvement in disease activity. Specifically, the ASDAS score did not decrease by at least 1.1 points after a minimum of 12 weeks of treatment, triggering escalation to this next step.

Next-line approach (partial)

When the first biologic or targeted agent has not met the response threshold, the direction involves switching to a different biologic DMARD or to a Janus kinase inhibitor — the specific options, conditions, and decision logic are set out in the full protocol below.

Treatment target

Clinically important improvement in ASDAS — a decrease of ≥1.1 — evaluated after at least 12 weeks of treatment.

References

Following a first b/tsDMARD failure, switching to another bDMARD (TNFi or IL-17i) or a JAKi should be considered.
Absence of response to treatment should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities.
Figure 3 summarises the criteria for continuation, namely that after at least 12 weeks of treatment, the disease activity has substantially decreased, as assessed by the ASDAS clinical important improvement, that is, improvement in ASDAS ≥1.1, together with the positive opinion from the rheumatologist to continue.

DOI: 10.1136/ard-2022-223296

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Ankylosing Spondylitis: What to Do When the First Biologic or JAK Inhibitor Has Not Worked

References