Biological or targeted-synthetic disease-modifying antirheumatic drug use for axial spondyloarthritis

Baeten, 2015Maxwell, 2015Poddubnyy, 2014

Biological or targeted-synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) are used by specialists for people with axial spondyloarthritis that has not responded adequately to exercise and NSAIDs. In most people, b/tsDMARDs are highly effective at decreasing disease activity and increasing function. However, convincing data about long-term disease modification and prevention of ankylosis are lacking.

The classes of b/tsDMARDs that are effective for the treatment of axial spondyloarthritis are tumour necrosis factor (TNF) inhibitors, interleukin (IL)-17 inhibitors, and Janus kinase (JAK) inhibitors. Not all of the drugs within these classes are currently listed on the Pharmaceutical Benefits Scheme (PBS) for nonradiographic axial spondyloarthritis or ankylosing spondylitis.

Under specialist supervision, people being treated with a bDMARD for axial spondyloarthritis who have persistent low disease activity may trial a reduction in the dose or increase in the dosing interval. However, therapy should not be stopped abruptly as this is associated with a high risk of disease flare. See An Australian Living Guideline for the Pharmacological Management of Inflammatory Arthritis for further advice.

The specialist will determine the appropriate approach to monitoring, screening for infection, and vaccination based on the adverse effect profile of the drug used and patient factors (eg disease activity, comorbidities). See Principles of immunomodulatory drug use for more detailed information.