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Vol. 3. Issue 6.
Pages 251-256 (November - December 2007)
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Vol. 3. Issue 6.
Pages 251-256 (November - December 2007)
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Indication for Anti-TNF-alpha Treatment in Patients With Ankylosing Spondylitis in Spain
Indicación de terapia anti-TNF alfa en pacientes con espondilitis anquilosante en España
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Pilar Font Ugaldea, Elisa Munoz Gomarizb, Eduardo Collantes Estevezc,
,1
, on behalf of the ISSAS Spanish Group
a Departamento de Medicina, Universidad de Córdoba, Córdoba, Spain
b Unidad de Investigación, Hospital Universitario Reina Sofía, Córdoba, Spain
c Servicio de Reumatología, Hospital Universitario Reina Sofía, Cordoba, Spain
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Objectives

To know the perception of Spanish rheumatologists of the profile of the patients with ankylosing spondyloarthritis, candidates for biological therapy treatment. To determine what proportion of patients with ankylosing spondylitis is considered a candidate for this therapy and to know up to what point this decision agrees with the recommendations of the ASAS working group on anti-TNF therapies and with the consensus of the SER.

Method

Rheumatologists from 19 Spanish centers who are experts in treating patients with AS and in the use of anti-TNF drugs participated in this study but they were not aware of the recommendations of the ASAS group and of the SER (unpublished until this work).

Results

One hundred and eighty five patients were included in the study. Spanish rheumatologists indicated that they would start therapy with anti-TNF drugs altogether in 37.8% of the patients. The candidates had the highest values of disease activity, of acute-phase reactants, the worst spinal mobility, worst function, most hip damage, and highest sick leave prevalence. Out of the total of the patients considered as candidates for treatment with biological therapies by their rheumatologists, 45.7% did not comply with the ASAS recommendations with respect to prior treatments with NSAIDs and BASDAI and 48.6% did not comply with the SER criteria; 29.1% of the patients who did not comply with the ASAS criteria (NSAIDs-BASDAI) were considered to be candidates for treatment with anti-TNF drugs; 29.6% of the patients who did not comply with the SER criteria were also considered to be candidates. The most important criterion was the clinical activity of the disease.

Conclusions

The agreement between the criteria applied by the Spanish rheumatologist and proposed by ASAS working group and the SER consensus is low. Axial affectation, activity, and severity in their disease were the criteria used but frequently by the Spanish rheumatologist to indicate biological therapy in patients with AS.

Key words:
Ankylosing spondylitis
Biologics therapies
Anti-TNF-alpha
Objetivos

Conocer el perfil que el reumatólogo español percibe del paciente con espondilitis anquilosante (EA) que es candidato a terapia biológica. Determinar qué proporción de pacientes con EA son candidatos a recibir este tratamiento y saber hasta qué punto esta decisión concuerda con las recomendaciones del grupo de trabajo Assessment in Ankylosing Spondylitis (ASAS working group) y de la Sociedad Española de Reumatología (SER) sobre el uso de terapias anti-TNF (factor de necrosis tumoral).

Método

Reumatólogos de 19 centros hospitalarios españoles, expertos en tratar a pacientes con EA y en el uso de fármacos anti-TNFα pero que desconocían las recomendaciones del grupo ASAS y de la SER (inéditas hasta este trabajo), tuvieron que evaluar a 10 pacientes con EA, de forma consecutiva, y decidir si cada uno de ellos comenzaría un tratamiento con fármacos anti-TNFα, según sus propios criterios.

Resultados

De 185 pacientes incluidos en el estudio, al 37,8% se clasificó como candidatos a anti-TNFα. Comparados con el resto del grupo, los candidatos tenían mayor grado de actividad inflamatoria, concentraciones más elevadas de velocidad de sedimentación globular (VSG) y proteína C reactiva (PCR), menor movilidad espinal, BASFI (Bath Ankylosing Spondylitis Functional Index) más elevado, afectación de la cadera con mayor frecuencia y alta prevalencia de baja por enfermedad. El 45,7% de los pacientes candidatos a tratamiento biológico no cumplían las recomendaciones de ASAS y el 48,6% los de la SER para el uso de anti-TNFα. Los reumatólogos españoles consideraron como candidatos para el tratamiento con anti-TNFα al 29,1 y el 29,6% de los pacientes que no cumplían los criterios de ASAS y la SER, respectivamente. El criterio más importante fue la actividad clínica de la enfermedad.

Conclusiones

La concordancia entre los criterios aplicados por los reumatólogos españoles y los propuestos por ASAS y SER es baja. Afectación axial, actividad y severidad de la enfermedad fueron los criterios usados más frecuentemente por los reumatólogos españoles para indicar terapia biológica en pacientes con EA.

Palabras clave:
Espondiloartritis anquilosante
Terapia biológica
Anti-TNFα
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At the end of the articles a list with the participants in the Spanish ISSAS Group is presented.

Copyright © 2007. Sociedad Española de Reumatología and Colegio Mexicano de Reumatología
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