Testing the Thresholds

Testing the Thresholds

Is the ASDAS appropriate for everyday clinical practice?

In patients with axial spondyloarthritis (axSpA) and persistent disease activity recommended to adapt treatment; treatment intensification should be considered for patients with persistently high disease activity.1 EULAR – The European Alliance of Associations for Rheumatology – in collaboration with the Assessment of SpondyloArthritis international Society (ASAS) state that high disease activity should be based on a composite score, the Ankylosing Spondylitis Disease Activity Score (ASDAS) with a cutoff ≥2.1.1

However, this recommendation is not always followed in practice. This could be because the ASDAS was developed for research, and it is not known how well it performs in daily practice. Possibly, the cut-off of 2.1 as currently endorsed may be too strict in an everyday setting. To address this, Webers and colleagues set out to investigate which ASDAS cut-off values correspond best with treatment intensification in practice.

Data were taken from a prospective multi-centre registry for SpA, and treatment intensification was defined as either higher dose or frequency of the same drug, switch to another drug, or addition of a new drug to the regimen – all due to inefficacy. Analyses were conducted both with all observations, and again with only the first observation per patient per calendar year, in order to achieve a balanced number of observations per patient by follow-up duration. Overall, 350 patients with 2,265 ASDAS measurements were included – and approximately two-thirds received a biologic or targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) at some point during follow-up.

The results, presented at the 2024 EULAR congress in Vienna, show that treatment intensification was applied after 10.4% of ASDAS measurements – and at the time of intensification, patients were often already on anti-inflammatory treatment. Treatment intensification often involved switching to another drug – typically within the same drug class – or adding a drug, and the use of conventional synthetic DMARD and corticosteroids was limited.

The mean ASDAS and proportion with ASDAS≥2.1 was higher at intensification timepoints than at non-intensification timepoints. When all ASDAS measurements were included for analysis, the optimal ASDAS cut-off related to treatment intenseification was 2.7, and results were similar when only one measurement was used per patient and calendar year. Of note, over the years, the optimal ASDAS cut-off varied substantially – from 2.3 to 2.8 – but was consistently higher than 2.1.

The researchers conclude that, in daily practice, treatment intensification is associated with a higher ASDAS cut-off value than the recommended one of 2.1. This could be because rheumatologists believe the recommended cut-off is too stringent, or consider factors other than disease activity when making treatment decisions. EULAR and ASAS recommend that treatment of axSpA should be individualised according to the current signs and symptoms of the disease, including axial, peripheral, and extramusculoskeletal manifestations – as well as each person’s characteristics, such as comorbidities and psychosocial factors.1

Webers C, et al. Which ASDAS Cut-Off Corresponds Best To Treatment Intensification In Patients With Axial Spondyloarthritis In Daily Practice? Presented at EULAR 2024; OP0060.
Ann Rheum Dis 2024; DOI: 10.1136/annrheumdis-2024-eular.2612.

1. Ramiro S, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023;82:19–34.

EULAR is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with rheumatic and musculoskeletal diseases (RMDs). EULAR aims to reduce the impact of RMDs on individuals and society, as well as improve RMD treatments, prevention, and rehabilitation. To this end, EULAR fosters excellence in rheumatology education and research, promotes the translation of research advances into daily care, and advocates for the recognition of the needs of those living with RMDs by EU institutions.

EULAR Communications, communications@eular.org

Notes to Editors
EULAR Recommendations
EULAR School of Rheumatology
EULAR Press Releases
Webers C, et al. Which ASDAS Cut-Off Corresponds Best To Treatment Intensification In Patients With Axial Spondyloarthritis In Daily Practice? Presented at EULAR 2024; OP0060.
Ann Rheum Dis 2024; DOI: 10.1136/annrheumdis-2024-eular.2612.
Regions: Europe, Switzerland
Keywords: Health, Medical, People in health research, Policy, Public Dialogue - health, Well being


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