Consensus Definition Developed for Difficult to Treat axSpA
A 2-round Delphi consensus process helped to define the components of difficult-to-treat axial spondyloarthritis (D2M axSpA), which was presented at the ACR Convergence in 2024.
The abstract was presented by Denis Poddubnyy, MD, PhD, professor of medicine in the division of rheumatology at the University of Toronto, Ontario, Canada. The research time sought to develop a consensus-based definition of D2M axSpA for use in clinical and research settings.
The consensus definition for D2M axSpA incorporated treatment failure, suboptimal disease control, and physician or patient acknowledgment of problematic signs and symptoms among patients who had been diagnosed with axSpA by a rheumatologist, Dr Poddubnyy explained. “Nonresponse to standard treatments represents a management challenge” in axSpA, he added.
The researchers conducted a scoping literature review in 2022 to identify potential definitions for D2M axSpA from prior studies, followed by a 2-round Delphi consensus process to identify components of D2M axSpA. The first Delphi round surveyed members of the Assessment of SpondyloArthritis international Society (ASAS) members, with 123 respondents. The second Delphi round applied the results of the discussion into consideration; a total of 186 responses were received. Based on the results of the second Delphi round, a draft D2M axSpA definition was developed and presented to the Task Force and subsequently to the ASAS members in January 2024. Full ASAS members (n=123) voted on the proposed definition.
The proposed definition was endorsed by ASAS at the annual meeting in January 2024 with 89% votes (109/123) in favor of the definition.
The resulting ASAS D2M axSpA definition is broad and includes a variety of factors that can lead to an unsatisfactory treatment outcome. The definition includes treatment-refractory disease, after excluding other reasons for the nonresponse among patients with a history of treatment failure and the presence of objective signs of inflammatory activity.
The ASAS D2M axSpA definition, shaped by extensive professional and patient input and a structured consensus process, provides a clear identification of patients with nonresponse to current standard treatments, paving a way to further research.
Reference:
Poddubnyy D Xenofon Baraliakos X, Compán VN, et al. 0819: The Assessment of SpondyloArthritis International Society (ASAS) Definition of Difficult-to-Manage Axial Spondyloarthritis. Presented at ACR Convergence. Washington, DC. November 16, 2024.
