Ankylosing Spondylitis with Significant Psoriasis — After IL-17A Inhibitor Failure
Clinical Scenario
This protocol applies to patients with ankylosing spondylitis who also have significant psoriasis. The presence of this skin comorbidity shapes the choice of biologic therapy from the outset.
Previous Treatment — Goals Not Met
The prior line of treatment used an IL-17A inhibitor. Escalation to this protocol occurs when that therapy did not achieve a clinically important improvement in disease activity — defined as an ASDAS decrease of at least 1.1 after a minimum of 12 weeks — and did not deliver adequate improvement in psoriasis skin outcomes.
Next-Line Approach (partial)
After failure of the initial biologic in this setting, the next step involves switching to a different biologic DMARD class or a targeted synthetic option. Which agent and in what order depends on the full structured protocol.
Treatment goal: a clinically important improvement in disease activity (ASDAS) after at least 12 weeks of the new therapy.
References
DOI: 10.1136/ard-2022-223296
- In patients with significant psoriasis, an IL-17i may be preferred.
- Following a first b/tsDMARD failure, switching to another bDMARD (TNFi or IL-17i) or a JAKi should be considered.
- 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.
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