Update on recommendations for eligibility of government subsidization of biologic disease‐modifying antirheumatic drugs for the treatment of axial spondyloarthritis in Singapore

Abstract

Aims The field of axial spondyloarthritis (axSpA) has undergone significant changes recently in particular with disease classification, assessment of disease activity and increased treatment options for biologics. In order to reflect these developments, we aimed to update the local consensus recommendations for subsidization of biologics. Methods A modified Delphi approach was used. Six published guidelines from major rheumatology societies and healthcare authorities on axSpA were reviewed. Findings were synthesized and used in formulating updated recommendation statements. Recommendations were rated by 10 practicing rheumatologists in Singapore. Consensus was reached if there was more than 70% agreement or disagreement. Results Ten statements achieved consensus. Patients may be considered for subsidization of biologic therapy if they fulfill the Assessment of Spondyloarthritis International Society or modified New York criteria, with persistently active disease (defined either by Ankylosing Spondylitis Disease Activity Score ≥ 2.1 or Bath Spondylitis Disease Activity Index ≥ 4), despite 4 weeks of full‐dose non‐steroidal anti‐inflammatory drugs and regular exercise. Either tumor necrosis factor inhibitors or interleukin 17 inhibitors may be used as first‐line therapy, and should be continued if adequate response is achieved at 6 months. Conclusion Recommendation statements were formulated through a formal consensus process by local experts with a view to assist relevant authorities in funding considerations and for use in clinical practice.

Consensus on targeted drug therapy for spondyloarthritis

“…At present, there are no head-to-head comparative studies available on TNF inhibitors versus IL-17A inhibitors for the treatment of AS, but guidelines from both China and abroad recommended that TNF inhibitors or IL-17A inhibitors can be used without preference of one over another after NSAIDs failure. [ 29 , 30 ] TNF inhibitors and IL-17A inhibitors have been approved by the US Food and Drug Administration for the treatment of nr-ax-SpA, but not yet in China.…”

MRI in axial spondyloarthritis: understanding an ‘ASAS-positive MRI’ and the ASAS classification criteria

“…Fourth, if the referring physician was not fully aware of the abovedescribed differences between classification and diagnosis, recording the MRI scan as ASAS-positive or ASAS-negative might be interpreted as a diagnostic statement. Fifth, in some countries, the indication for prescribing certain drugs depends on ASAS or mNYC positivity [39]. Legal problems could occur if, for example, an insurance provider links the approval of a certain therapy to classification and the radiology report states a different opinion from the conclusion of the rheumatologist [40].…”