Comparison of recommendations for the use of anti-tumour necrosis factor therapy in ankylosing spondylitis in 23 countries worldwide

Rheumatology (Oxford). 2011 Dec;50(12):2270-7. doi: 10.1093/rheumatology/ker270. Epub 2011 Oct 22.


Objective: To give an overview of the recommendations for the use of anti-TNF-α therapy in AS in 23 countries worldwide.

Methods: The recommendations were collected, translated and a summary was checked by Assessment of SpondyloArthritis International Society (ASAS) members from the respective countries. The recommendations were compared with the ASAS recommendations (2006) on three aspects: patient selection for initiation of treatment (diagnosis, disease activity, previous treatment and contraindications), assessment of disease and assessment of response.

Results: The majority of the recommendations are similar to the ASAS recommendation with regard to patient selection, assessment of disease and treatment response. Additional objective assessments of disease activity are required in eight countries, leading to a more strict indication to start anti-TNF-α therapy. CONCLUSION; Most national recommendations follow the international ASAS recommendations, suggesting that the latter are widely implemented. This might contribute to comparable access with anti-TNF-α treatment across countries. This article shows that general consensus exists about the use of anti-TNF-α therapy in AS across the world, although some countries require additional objective signs of inflammation and/or more pre-treatment, which limits access.

Publication types

  • Comparative Study

MeSH terms

  • Asia
  • Canada
  • Colombia
  • Consensus
  • Europe
  • Humans
  • Mexico
  • Practice Guidelines as Topic*
  • Societies, Medical
  • Spondylitis, Ankylosing / diagnosis
  • Spondylitis, Ankylosing / therapy*
  • Treatment Failure
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*


  • Tumor Necrosis Factor-alpha