Supplementary File 4

Spanish Society of Rheumatology

Appropriateness Criteria for Reducing the Dose of Biological Therapies in

Peripheral Spondyloarthritis

Variables selected by the Working Group to develop the list of “indications” or “clinical scenarios” in which the appropriateness of the BT dose reduction was evaluated by the Rating Panel

Definitions

1. Peripheral spondyloarthritis (pSpA)

Patients who meet the definition of predominantly peripheral spondyloarthritis published in 2011 by the Assessment of SpondyloArthritis International Society (ASAS)1:

*Peripheral arthritis: usually predominantly lower limb and/or asymmetric arthritis.

SpA: Spondyloarthritis; HLA-B27: Human leucocyte antigen B27; IBP: inflammatory back pain.

Figure from Rudwaleit et al.1

2. Therapeutic goal (TG) in pSpA

Low activity or remission with the following definitions:

a)Remission. The patient meets the following criteria: no painful or swollen joints, pain on the visual analogue scale is 0, the patient’s global assessment of disease activity is 0, and the number of painful enthesitis/dactylitis is 02.

b)Low activity:The patient meets the following criteria: number of tender and swollen joints ≤1, pain on the visual analogue scale ≤ 1·5, patient global assessment of disease activity ≤ 2, and number of painful enthesitis/dactylitis ≤ 1. If the score is 0, then the patient is in remission2.

3. Time on therapeutic goal

Time the patient maintains the TG. Time in TG less than 6 months was not taken into consideration because BT dose should not be reducedin these patients before 6 months2. Therefore, the 2 categories consideredwere as follows:

a) More than 12 months.

b) Between 6 and 12 months.

4. Enthesitis

Enthesitis diagnosed by a rheumatologist at some point duringthe courseof the disease.

5. Dactylitis

Dactylitis diagnosed by a rheumatologist at some point duringthe courseof the disease.

6. Duration of disease (pSpA) course

Time from the beginning of pSpA symptoms until the time the decision to reduce the BT dose arises, with 2categories:

a)Less than 5 years.

b)5 years or more.

7. C-reactive protein (CRP) when biological therapy (BT) was started

CRP value at the time BT began.The 2 categories considered were normal CRP and high CRP, with the following definitions:

a)Normal CRP: CRP less than or equal to the upper limit of normal in the center where the patient was treated.

b)High CRP: CRP higher than the upper limit of normal in the center where the patient was treated.2

8. Current C-reactive protein

CRP value at the time the decision to reduce dose of BTarises.The 2 categories considered were normal CRP and high CRP (see definition 7).

9. Current disease (pSpA) activity

Disease activity at the time the decision to reduce the dose of BTarises.Disease activity higher than “low activity” was nottaken into considerationbecause BT dose is not reduced in these patients. Therefore, the 2 categories considered were “in remission” and “low activity”, with the following definitions:

a)Remission (see definition 2).

b)Low activity (see definition 2).

10. Time to achieve the therapeutic goal

Time since the BT started until the TG (see definition 2) was reached, with 2categories:

a)Less than 6months.

b)6months or more.

11. Previous failures with BT

Suspension of any BT because of lack of effectiveness according to the physician, with 3categories:

a)No previous failures with BT.

b)One previous failure with BT.

c)Two or more previous failures with BT.

12. Type of therapy

Combination of drug groups used forthe management of RA. The 2 categories considered were monotherapy and combined therapy, with the following definitions:

a)Monotherapy: Treatment with BT without concomitant disease-modifying antirheumatic drugs (DMARDs), regardless of the dose ofcorticosteroid. The drugs considered to be DMARDs are as follows: methotrexate, leflunomide, sulfasalazine, antimalarials, cyclosporine A, azathioprine, and mycophenolate.

b)Combined therapy: Treatment with BT in combination with some DMARDs, regardless of the doseof corticosteroids. The drugs considered to be DMARDs are as follows: methotrexate, leflunomide, sulfasalazine, antimalarials, cyclosporine A, azathioprine, and mycophenolate.2

13. Corticodependence

The patient is on corticosteroidtherapy at a dose higher than5 mg/day of prednisone. The 2 categories considered were without corticodependence and with corticodependence, defined as follows:

a)Without corticodependence:the patient receives corticosteroids at a dose ≤5 mg/day of prednisone.

b)With corticodependence:the patient receives corticosteroids at a dose >5 mg/day of prednisone.2

14. Uveitis

Uveitis diagnosed by an ophthalmologist.The 2 categories considered were as follows:

a)Without uveitis in the past year.

b)With uveitis in the past year.

References

1. Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011; 70(1): 25-31.

2. Gonzalez-Alvaro I, Martinez-Fernandez C, Dorantes-Calderon B, Garcia-Vicuna R, Hernandez-Cruz B, Herrero-Ambrosio A, et al. Spanish Rheumatology Society and Hospital Pharmacy Society Consensus on recommendations for biologics optimization in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Rheumatology (Oxford). 2015; 54(7): 1200-9.

Figure S7. Proportion of appropriate (green), inappropriate (red), or uncertain (yellow) indications for peripheral spondyloarthritis

FigureS8. Algorithm for easier navigation through the BT dose reduction appropriateness criteria matrix. Click the hyperlink to access the table.

Figure S9. Proportion of appropriate (green), inappropriate (red), or uncertain (yellow) indications depending on variables used to develop the list of indications.


Table S25.Chapter I.1.a.1.Peripheral spondyloarthritis.Time in TG > 12 months.With neither dactylitis nor enthesitis.Disease duration< 5 years.Current disease activity: Remission.

Normal CRP at BT start / High CRP at BT start / Indications number
Current CRP: Normal / Current CRP: High / Current CRP: Normal / Current CRP: High
M / Appr. / M / Appr. / M / Appr. / M / Appr.
Time to achieve TG < 6 months
No previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 8.0 / A / 6.0 / U / 8.0 / A / 5.0 / U / 1 - 4
Uveitis in the last year / 7.0 / A / 4.5 / U / 7.0 / A / 4.0 / U / 5 - 8
With corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 7.0 / A / 4.0 / U / 9 - 12
Uveitis in the last year / 5.5 / U / 4.0 / U / 6.0 / U / 3.5 / U / 13 - 16
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 8.5 / A / 6.0 / U / 8.5 / A / 5.0 / U / 17 - 20
Uveitis in the last year / 7.0 / A / 4.0 / U / 6.0 / U / 4.0 / U / 21 - 24
With corticodependence
No uveitis in the last year / 8.0 / A / 5.0 / U / 7.0 / A / 4.5 / U / 25 - 28
Uveitis in the last year / 6.0 / U / 4.0 / U / 5.0 / U / 3.5 / U / 29 - 32
One previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 7.5 / A / 5.0 / U / 7.5 / A / 5.0 / U / 33 - 36
Uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 4.0 / U / 37 - 40
With corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 4.0 / U / 41 - 44
Uveitis in the last year / 4.5 / U / 3.0 / I / 4.0 / U / 3.0 / I / 45 - 48
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 8.0 / A / 6.0 / U / 8.0 / A / 5.0 / U / 49 - 52
Uveitis in the last year / 7.0 / A / 4.5 / U / 5.5 / U / 4.0 / U / 53 - 56
With corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 6.0 / U / 4.0 / U / 57 - 60
Uveitis in the last year / 5.0 / U / 4.0 / U / 4.0 / U / 4.0 / U / 61 - 64
Two or more previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 7.0 / A / 4.5 / U / 65 - 68
Uveitis in the last year / 5.0 / U / 3.5 / U / 5.0 / U / 3.5 / U / 69 - 72
With corticodependence
No uveitis in the last year / 5.0 / U / 4.0 / U / 5.5 / U / 3.5 / U / 73 - 76
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 77 - 80
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 7.0 / A / 4.0 / U / 81 - 84
Uveitis in the last year / 5.5 / U / 3.5 / U / 5.5 / U / 3.0 / I / 85 - 88
With corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 3.0 / I / 89 - 92
Uveitis in the last year / 4.0 / U / 2.5 / I / 4.0 / U / 2.5 / I / 93 - 96
Time to achieve TG ≥6 months
No previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 8.0 / A / 6.0 / U / 7.5 / A / 5.0 / U / 97 - 100
Uveitis in the last year / 6.0 / U / 4.5 / U / 5.5 / U / 4.0 / U / 101 - 104
With corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 6.0 / U / 5.0 / U / 105 - 108
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 2.5 / I / 109 - 112
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 8.0 / A / 6.0 / U / 7.0 / A / 5.0 / U / 113 - 116
Uveitis in the last year / 7.0 / A / 4.5 / U / 5.5 / U / 3.5 / U / 117 - 120
With corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 6.0 / U / 4.0 / U / 121 - 124
Uveitis in the last year / 6.0 / U / 4.0 / U / 4.5 / U / 3.0 / I / 125 - 128
One previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 6.0 / U / 4.0 / U / 129 - 132
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.0 / I / 133 - 136
With corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 5.0 / U / 4.0 / U / 137 - 140
Uveitis in the last year / 4.0 / U / 2.5 / I / 4.0 / U / 2.5 / I / 141 - 144
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 6.0 / U / 4.5 / U / 145 - 148
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.5 / U / 149 - 152
With corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 3.0 / I / 153 - 156
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 2.5 / I / 157 - 160
Two or more previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.5 / A / 4.0 / U / 6.0 / U / 3.5 / U / 161 - 164
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 165 - 168
With corticodependence
No uveitis in the last year / 5.0 / U / 3.5 / U / 4.0 / U / 3.0 / I / 169 - 172
Uveitis in the last year / 3.0 / I / 2.5 / I / 3.5 / U / 2.0 / I / 173 - 176
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.0 / A / 4.0 / U / 7.0 / A / 4.0 / U / 177 - 180
Uveitis in the last year / 5.0 / U / 3.5 / U / 4.0 / U / 3.0 / I / 181 - 184
With corticodependence
No uveitis in the last year / 5.5 / U / 4.0 / U / 5.5 / U / 2.5 / I / 185 - 188
Uveitis in the last year / 4.0 / U / 3.0 / I / 3.5 / U / 1.5 / I / 189 - 192

TG: Therapeutic goal. BT: Biological therapy. M: Median. Appr.: Appropriateness (A: Appropriate; U: Uncertain; I: Inappropriate). CRP: C-reactive protein.

Table S26. Chapter I.1.a.2.Peripheral spondyloarthritis.Time in TG > 12 months.With neither dactylitis nor enthesitis.Disease duration < 5 years.Current disease activity: Low.

Normal CRP at BT start / High CRP at BT start / Indications number
Current CRP: Normal / Current CRP: High / Current CRP: Normal / Current CRP: High
M / Appr. / M / Appr. / M / Appr. / M / Appr.
Time to achieve TG < 6 months
No previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.5 / U / 7.0 / A / 4.5 / U / 193 - 196
Uveitis in the last year / 5.0 / U / 3.5 / U / 5.0 / U / 3.5 / U / 197 - 200
With corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 4.0 / U / 201 - 204
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 205 - 208
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.5 / A / 5.5 / U / 7.5 / A / 4.0 / U / 209 - 212
Uveitis in the last year / 5.5 / U / 4.0 / U / 5.5 / U / 3.0 / I / 213 - 216
With corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 6.0 / U / 3.5 / U / 217 - 220
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.0 / I / 221 - 224
One previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.0 / U / 4.5 / U / 6.0 / U / 4.0 / U / 225 - 228
Uveitis in the last year / 5.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 229 - 232
With corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 5.0 / U / 3.0 / I / 233 - 236
Uveitis in the last year / 4.0 / U / 2.5 / I / 3.0 / I / 3.0 / I / 237 - 240
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 4.0 / U / 241 - 244
Uveitis in the last year / 4.5 / U / 3.0 / I / 5.0 / U / 3.0 / I / 245 - 248
With corticodependence
No uveitis in the last year / 5.5 / U / 4.0 / U / 5.5 / U / 3.0 / I / 249 - 252
Uveitis in the last year / 3.5 / U / 2.5 / I / 3.0 / I / 2.5 / I / 253 - 256
Two or more previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 5.0 / U / 4.0 / U / 257 - 260
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.5 / U / 3.0 / I / 261 - 264
With corticodependence
No uveitis in the last year / 5.0 / U / 3.5 / U / 4.5 / U / 3.0 / I / 265 - 268
Uveitis in the last year / 3.0 / I / 2.5 / I / 3.0 / I / 2.0 / I / 269 - 272
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 6.0 / U / 5.0 / U / 5.5 / U / 4.0 / U / 273 - 276
Uveitis in the last year / 4.5 / U / 4.0 / U / 5.0 / U / 3.0 / I / 277 - 280
With corticodependence
No uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.5 / U / 281 - 284
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 285 - 288
Time to achieve TG ≥6 months
No previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.0 / U / 5.0 / U / 6.5 / A / 4.0 / U / 289 - 292
Uveitis in the last year / 4.5 / U / 3.5 / U / 5.0 / U / 3.0 / I / 293 - 296
With corticodependence
No uveitis in the last year / 5.5 / U / 4.0 / U / 5.5 / U / 3.0 / I / 297 - 300
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 2.5 / I / 301 - 304
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 7.0 / A / 4.0 / U / 305 - 308
Uveitis in the last year / 5.0 / U / 3.5 / U / 5.0 / U / 3.0 / I / 309 - 312
With corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 3.0 / I / 313 - 316
Uveitis in the last year / 5.0 / U / 3.5 / U / 4.0 / U / 2.5 / I / 317 - 320
One previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 4.0 / U / 321 - 324
Uveitis in the last year / 4.5 / U / 3.0 / I / 4.0 / U / 3.0 / I / 325 - 328
With corticodependence
No uveitis in the last year / 5.0 / U / 3.5 / U / 5.0 / U / 3.5 / U / 329 - 332
Uveitis in the last year / 3.5 / U / 2.0 / I / 3.0 / I / 2.0 / I / 333 - 336
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 7.0 / A / 4.0 / U / 337 - 340
Uveitis in the last year / 4.5 / U / 4.0 / U / 5.0 / U / 3.0 / I / 341 - 344
With corticodependence
No uveitis in the last year / 5.5 / U / 4.0 / U / 5.5 / U / 3.0 / I / 345 - 348
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 2.5 / I / 349 - 352
Two or more previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 5.0 / U / 3.0 / I / 5.0 / U / 3.0 / I / 353 - 356
Uveitis in the last year / 3.5 / U / 2.0 / I / 3.0 / I / 2.0 / I / 357 - 360
With corticodependence
No uveitis in the last year / 4.0 / U / 3.0 / I / 5.0 / U / 3.0 / I / 361 - 364
Uveitis in the last year / 3.0 / I / 1.5 / I / 2.5 / I / 1.5 / I / 365 - 368
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 5.0 / U / 4.0 / U / 5.5 / U / 4.0 / U / 369 - 372
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 373 - 376
With corticodependence
No uveitis in the last year / 4.0 / U / 3.0 / I / 4.5 / U / 3.0 / I / 377 - 380
Uveitis in the last year / 3.0 / I / 2.0 / I / 3.0 / I / 2.0 / I / 381 - 384

TG: Therapeutic goal. BT: Biological therapy. M: Median. Appr.: Appropriateness (A: Appropriate; U: Uncertain; I: Inappropriate). CRP: C-reactive protein.

Table S27. Chapter I.1.b.1.Peripheral spondyloarthritis.Time in TG > 12 months.With neitherdactylitis nor enthesitis.Disease duration ≥ 5 years.Current disease activity: Remission.

Normal CRP at BT start / High CRP at BT start / Indications number
Current CRP: Normal / Current CRP: High / Current CRP: Normal / Current CRP: High
M / Appr. / M / Appr. / M / Appr. / M / Appr.
Time to achieve TG < 6 months
No previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 8.0 / A / 5.0 / U / 8.0 / A / 5.0 / U / 385 - 388
Uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 4.0 / U / 389 - 392
With corticodependence
No uveitis in the last year / 6.0 / U / 4.5 / U / 6.5 / A / 4.0 / U / 393 - 396
Uveitis in the last year / 4.5 / U / 3.5 / U / 5.0 / U / 3.0 / I / 397 - 400
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 8.0 / A / 6.0 / U / 8.0 / A / 5.0 / U / 401 - 404
Uveitis in the last year / 6.0 / U / 5.0 / U / 5.0 / U / 4.0 / U / 405 - 408
With corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 6.5 / A / 4.0 / U / 409 - 412
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.5 / U / 413 - 416
One previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 7.0 / A / 4.5 / U / 7.0 / A / 5.0 / U / 417 - 420
Uveitis in the last year / 5.0 / U / 3.5 / U / 5.0 / U / 3.5 / U / 421 - 424
With corticodependence
No uveitis in the last year / 6.5 / A / 3.5 / U / 5.5 / U / 4.0 / U / 425 - 428
Uveitis in the last year / 4.0 / U / 3.5 / U / 4.0 / U / 3.5 / U / 429 - 432
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 7.0 / A / 5.0 / U / 433 - 436
Uveitis in the last year / 5.0 / U / 4.0 / U / 6.0 / U / 3.0 / I / 437 - 440
With corticodependence
No uveitis in the last year / 6.0 / U / 4.5 / U / 6.0 / U / 3.5 / U / 441 - 444
Uveitis in the last year / 4.5 / U / 3.5 / U / 5.0 / U / 3.0 / I / 445 - 448
Two or more previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.5 / A / 4.0 / U / 7.0 / A / 4.0 / U / 449 - 452
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 453 - 456
With corticodependence
No uveitis in the last year / 5.0 / U / 3.5 / U / 5.0 / U / 4.0 / U / 457 - 460
Uveitis in the last year / 3.5 / U / 3.0 / I / 4.0 / U / 3.0 / I / 461 - 464
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 7.0 / A / 4.0 / U / 465 - 468
Uveitis in the last year / 5.0 / U / 4.0 / U / 4.5 / U / 3.0 / I / 469 - 472
With corticodependence
No uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 4.0 / U / 473 - 476
Uveitis in the last year / 4.0 / U / 3.0 / I / 3.5 / U / 3.0 / I / 477 - 480
Time to achieve TG ≥6 months
No previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 7.0 / A / 5.0 / U / 481 - 484
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 4.0 / U / 485 - 488
With corticodependence
No uveitis in the last year / 6.0 / U / 4.5 / U / 5.5 / U / 4.0 / U / 489 - 492
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 493 - 496
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.5 / A / 6.0 / U / 8.0 / A / 5.0 / U / 497 - 500
Uveitis in the last year / 6.0 / U / 4.5 / U / 6.0 / U / 4.0 / U / 501 - 504
With corticodependence
No uveitis in the last year / 6.0 / U / 5.0 / U / 6.0 / U / 3.5 / U / 505 - 508
Uveitis in the last year / 4.5 / U / 3.5 / U / 4.5 / U / 3.0 / I / 509 - 512
One previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.0 / U / 4.5 / U / 7.0 / A / 4.5 / U / 513 - 516
Uveitis in the last year / 4.0 / U / 3.5 / U / 4.5 / U / 3.0 / I / 517 - 520
With corticodependence
No uveitis in the last year / 5.5 / U / 4.0 / U / 6.0 / U / 4.0 / U / 521 - 524
Uveitis in the last year / 3.5 / U / 3.0 / I / 4.0 / U / 3.0 / I / 525 - 528
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 7.0 / A / 4.0 / U / 529 - 532
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.0 / I / 533 - 536
With corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 3.0 / I / 537 - 540
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 541 - 544
Two or more previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.5 / A / 3.5 / U / 6.0 / U / 3.0 / I / 545 - 548
Uveitis in the last year / 3.5 / U / 3.0 / I / 4.0 / U / 3.0 / I / 549 - 552
With corticodependence
No uveitis in the last year / 5.0 / U / 3.5 / U / 5.0 / U / 3.0 / I / 553 - 556
Uveitis in the last year / 3.5 / U / 3.0 / I / 3.5 / U / 3.0 / I / 557 - 560
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 6.5 / A / 4.0 / U / 6.5 / A / 4.0 / U / 561 - 564
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.5 / U / 3.0 / I / 565 - 568
With corticodependence
No uveitis in the last year / 5.0 / U / 3.0 / I / 5.5 / U / 3.0 / I / 569 - 572
Uveitis in the last year / 3.5 / U / 3.0 / I / 4.0 / U / 3.0 / I / 573 - 576

TG: Therapeutic goal. BT: Biological therapy. M: Median. Appr.: Appropriateness (A: Appropriate; U: Uncertain; I: Inappropriate). CRP: C-reactive protein.

Table S28. Chapter I.1.b.2.Peripheral spondyloarthritis.Time in TG > 12 months.With neitherdactylitis nor enthesitis.Disease duration ≥ 5 years.Current disease activity: Low.

Normal CRP at BT start / High CRP at BT start / Indications number
Current CRP: Normal / Current CRP: High / Current CRP: Normal / Current CRP: High
M / Appr. / M / Appr. / M / Appr. / M / Appr.
Time to achieve TG < 6 months
No previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 4.0 / U / 577 - 580
Uveitis in the last year / 5.0 / U / 3.0 / I / 5.0 / U / 3.0 / I / 581 - 584
With corticodependence
No uveitis in the last year / 5.0 / U / 3.5 / U / 5.5 / U / 3.0 / I / 585 - 588
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 589 - 592
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.0 / A / 4.0 / U / 7.0 / A / 4.0 / U / 593 - 596
Uveitis in the last year / 5.5 / U / 4.0 / U / 5.0 / U / 3.0 / I / 597 - 600
With corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 3.0 / I / 601 - 604
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.5 / U / 3.0 / I / 605 - 608
One previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 4.0 / U / 609 - 612
Uveitis in the last year / 5.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 613 - 616
With corticodependence
No uveitis in the last year / 5.0 / U / 3.0 / I / 5.0 / U / 3.0 / I / 617 - 620
Uveitis in the last year / 4.0 / U / 3.0 / I / 3.5 / U / 3.0 / I / 621 - 624
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 6.5 / A / 4.0 / U / 6.5 / A / 4.0 / U / 625 - 628
Uveitis in the last year / 5.0 / U / 3.0 / I / 5.0 / U / 3.0 / I / 629 - 632
With corticodependence
No uveitis in the last year / 5.5 / U / 3.0 / I / 6.0 / U / 3.0 / I / 633 - 636
Uveitis in the last year / 4.0 / U / 2.5 / I / 3.5 / U / 2.5 / I / 637 - 640
Two or more previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 5.5 / U / 4.0 / U / 5.0 / U / 3.0 / I / 641 - 644
Uveitis in the last year / 3.5 / U / 2.5 / I / 3.5 / U / 2.5 / I / 645 - 648
With corticodependence
No uveitis in the last year / 4.0 / U / 3.0 / I / 4.5 / U / 3.0 / I / 649 - 652
Uveitis in the last year / 3.0 / I / 2.5 / I / 3.0 / I / 2.5 / I / 653 - 656
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 3.5 / U / 657 - 660
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 661 - 664
With corticodependence
No uveitis in the last year / 5.0 / U / 3.0 / I / 5.0 / U / 3.0 / I / 665 - 668
Uveitis in the last year / 3.0 / I / 2.5 / I / 3.0 / I / 2.0 / I / 669 - 672
Time to achieve TG ≥6 months
No previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 4.0 / U / 673 - 676
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 677 - 680
With corticodependence
No uveitis in the last year / 5.0 / U / 3.5 / U / 5.0 / U / 3.0 / I / 681 - 684
Uveitis in the last year / 3.5 / U / 3.0 / I / 3.0 / I / 2.5 / I / 685 - 688
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 6.5 / A / 4.0 / U / 689 - 692
Uveitis in the last year / 4.5 / U / 4.0 / U / 4.5 / U / 3.0 / I / 693 - 696
With corticodependence
No uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 4.0 / U / 697 - 700
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 701 - 704
One previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 5.5 / U / 3.5 / U / 5.5 / U / 3.5 / U / 705 - 708
Uveitis in the last year / 3.5 / U / 3.0 / I / 3.5 / U / 3.0 / I / 709 - 712
With corticodependence
No uveitis in the last year / 5.0 / U / 3.0 / I / 4.0 / U / 2.5 / I / 713 - 716
Uveitis in the last year / 3.5 / U / 3.0 / I / 3.0 / I / 3.0 / I / 717 - 720
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 4.0 / U / 721 - 724
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 725 - 728
With corticodependence
No uveitis in the last year / 4.5 / U / 3.0 / I / 4.5 / U / 3.0 / I / 729 - 732
Uveitis in the last year / 3.5 / U / 2.5 / I / 3.0 / I / 3.0 / I / 733 - 736
Two or more previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 5.0 / U / 3.0 / I / 4.5 / U / 3.0 / I / 737 - 740
Uveitis in the last year / 3.0 / I / 2.5 / I / 3.0 / I / 2.0 / I / 741 - 744
With corticodependence
No uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 745 - 748
Uveitis in the last year / 3.0 / I / 2.5 / I / 3.0 / I / 2.5 / I / 749 - 752
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 5.5 / U / 4.0 / U / 5.0 / U / 3.0 / I / 753 - 756
Uveitis in the last year / 4.0 / U / 3.0 / I / 3.5 / U / 3.0 / I / 757 - 760
With corticodependence
No uveitis in the last year / 4.5 / U / 3.0 / I / 4.0 / U / 3.0 / I / 761 - 764
Uveitis in the last year / 3.0 / I / 2.5 / I / 3.0 / I / 2.5 / I / 765 - 768

TG: Therapeutic goal. BT: Biological therapy. M: Median. Appr.: Appropriateness (A: Appropriate; U: Uncertain; I: Inappropriate). CRP: C-reactive protein.

Table S29. Chapter I.2.a.1.Peripheral spondyloarthritis.Time in TG > 12 months.With dactylitis and/or enthesitis.Disease duration < 5 years.Current disease activity: Remission.

Normal CRP at BT start / High CRP at BT start / Indications number
Current CRP: Normal / Current CRP: High / Current CRP: Normal / Current CRP: High
M / Appr. / M / Appr. / M / Appr. / M / Appr.
Time to achieve TG < 6 months
No previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 7.5 / A / 5.0 / U / 7.0 / A / 4.5 / U / 769 - 772
Uveitis in the last year / 6.0 / U / 4.0 / U / 5.5 / U / 4.0 / U / 773 - 776
With corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 3.0 / I / 777 - 780
Uveitis in the last year / 5.0 / U / 3.5 / U / 4.5 / U / 3.0 / I / 781 - 784
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 8.0 / A / 5.0 / U / 8.0 / A / 4.0 / U / 785 - 788
Uveitis in the last year / 5.5 / U / 4.0 / U / 6.0 / U / 3.5 / U / 789 - 792
With corticodependence
No uveitis in the last year / 7.0 / A / 4.5 / U / 6.5 / A / 4.0 / U / 793 - 796
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.0 / I / 797 - 800
One previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.5 / A / 4.0 / U / 6.5 / A / 4.0 / U / 801 - 804
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.0 / I / 805 - 808
With corticodependence
No uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 4.0 / U / 809 - 812
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 813 - 816
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.5 / A / 5.0 / U / 7.5 / A / 4.0 / U / 817 - 820
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.0 / I / 821 - 824
With corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 4.5 / U / 825 - 828
Uveitis in the last year / 4.0 / U / 4.0 / U / 4.5 / U / 3.0 / I / 829 - 832
Two or more previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 6.0 / U / 3.0 / I / 833 - 836
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 837 - 840
With corticodependence
No uveitis in the last year / 5.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 841 - 844
Uveitis in the last year / 3.0 / I / 2.5 / I / 3.0 / I / 2.5 / I / 845 - 848
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 6.0 / U / 4.0 / U / 849 - 852
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.0 / I / 853 - 856
With corticodependence
No uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.0 / I / 857 - 860
Uveitis in the last year / 4.0 / U / 2.5 / I / 3.5 / U / 2.0 / I / 861 - 864
Time to achieve TG ≥6 months
No previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 7.0 / A / 4.0 / U / 865 - 868
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.0 / I / 869 - 872
With corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 4.5 / U / 3.0 / I / 873 - 876
Uveitis in the last year / 4.5 / U / 3.0 / I / 3.5 / U / 2.5 / I / 877 - 880
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.5 / A / 5.0 / U / 6.5 / A / 4.0 / U / 881 - 884
Uveitis in the last year / 5.5 / U / 4.0 / U / 5.0 / U / 3.5 / U / 885 - 888
With corticodependence
No uveitis in the last year / 6.5 / A / 4.0 / U / 5.0 / U / 4.0 / U / 889 - 892
Uveitis in the last year / 5.0 / U / 3.5 / U / 4.0 / U / 3.0 / I / 893 - 896
One previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 6.5 / A / 5.0 / U / 6.5 / A / 4.0 / U / 897 - 900
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.0 / I / 901 - 904
With corticodependence
No uveitis in the last year / 5.0 / U / 4.0 / U / 4.0 / U / 3.5 / U / 905 - 908
Uveitis in the last year / 4.0 / U / 3.0 / I / 3.0 / I / 2.5 / I / 909 - 912
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 7.0 / A / 5.0 / U / 6.0 / U / 4.5 / U / 913 - 916
Uveitis in the last year / 5.0 / U / 4.0 / U / 5.0 / U / 3.0 / I / 917 - 920
With corticodependence
No uveitis in the last year / 5.5 / U / 4.0 / U / 5.0 / U / 3.5 / U / 921 - 924
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 925 - 928
Two or more previous failure with BT
Type of therapy: Monotherapy
Without corticodependence
No uveitis in the last year / 5.5 / U / 4.0 / U / 5.0 / U / 3.5 / U / 929 - 932
Uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 933 - 936
With corticodependence
No uveitis in the last year / 4.0 / U / 3.0 / I / 4.0 / U / 3.0 / I / 937 - 940
Uveitis in the last year / 3.0 / I / 2.5 / I / 2.5 / I / 1.5 / I / 941 - 944
Type of therapy: Combined
Without corticodependence
No uveitis in the last year / 6.0 / U / 4.0 / U / 5.5 / U / 4.0 / U / 945 - 948
Uveitis in the last year / 4.5 / U / 4.0 / U / 4.0 / U / 3.0 / I / 949 - 952
With corticodependence
No uveitis in the last year / 5.0 / U / 4.0 / U / 4.0 / U / 3.0 / I / 953 - 956
Uveitis in the last year / 4.0 / U / 3.0 / I / 3.0 / I / 2.0 / I / 957 - 960

TG: Therapeutic goal. BT: Biological therapy. M: Median. Appr.: Appropriateness (A: Appropriate; U: Uncertain; I: Inappropriate). CRP: C-reactive protein.