Pharmacotherapy (excluding biotherapies) for ankylosing spondylitis: development of recommendations for clinical practice based on published evidence and expert opinion.

Abstract

OBJECTIVES:

To develop recommendations about pharmacotherapy (excluding biotherapeutic agents) in patients with axial forms of ankylosing spondylitis (AS) seen in everyday clinical practice.

METHODS:

The recommendations were based on evidence from the literature. First, a scientific committee used a Delphi procedure to select five focal points about which recommendations were needed. Then, a literature task force looked for relevant publications in the following: Cochrane, PubMed, and Ovid databases; and abstracts from the French Society for Rheumatology, European League against Rheumatism, and American College of Rheumatology. Based on the data in these publications, recommendations were drafted then validated by a group of experts. The strength of each recommendation was determined, as well as the extent of agreement among the experts.

RESULTS:

The four focal points were the best strategy for using nonsteroidal anti-inflammatory drugs, role for systemic glucocorticoid therapy, role for glucocorticoid injections into the sacroiliac joints and entheses, and role for slow-acting drugs (e.g., methotrexate, sulfasalazine, leflunomide, thalidomide, and pamidronate). Of the 661 promising publications identified by the literature search, 173 were found to be relevant. The evidence in these 173 papers was reported to experts during interactive workshops. At the end of the workshops, the experts drafted recommendations, which were then validated by having all panel participants vote during a final meeting. There were seven recommendations, whose strength ranged from A to D.

CONCLUSION:

Seven recommendations about pharmacotherapy in patients with AS were developed. They can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of patients with AS in France.

• Authors: Frédéric Lavie, Stephan Pavy, Emmanuelle Dernis, Philippe Goupille, Alain Cantagrel, Jacques Tebib, Pascal Claudepierre, René Marc Flipo, Xavier Le Loët, Jean-Francis Maillefert, Xavier Mariette, Alain Saraux, Thierry Schaeverbeke, Daniel Wendling, Bernard Combe
• Journal: Joint bone spine (Joint Bone Spine) Vol. 74 Issue 4 Pg. 346-52 (Jul 2007) ISSN: 1778-7254 [Electronic] France
• PMID: 17590370 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal

Topics

• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Consensus
• Evidence-Based Medicine
• Female
• Follow-Up Studies
• France
• Humans
• Male
• Practice Guidelines as Topic
• Randomized Controlled Trials as Topic
• Sensitivity and Specificity
• Spondylitis, Ankylosing (diagnosis, drug therapy)
• Treatment Outcome