"Promotions" in clinical guidelines recommended by Treasury

The sudden emergence of scuziumab has opened up a new situation for the treatment of as.ankylosing spondylitis (AS) is a kind of autoimmune disease. The sacroiliac joint and spinal attachment inflammation are the main diseases, and the incidence rate and disability rate of male patients are many. Many patients suffering from this disease have structural dysfunction in the course of disease, and they have lost their labor, which has brought great pain to family and society.in order to standardize the diagnosis and treatment of as, many international organizations, such as the international society for the assessment of spinal arthritis (ASAS), the European Union Against Rheumatism (EULAR), the American Society of Rheumatology (ACR), the American Association of spondylitis (SAA) and the professional organizations of Rheumatology in some countries have issued corresponding treatment guidelines.with the continuous improvement of diagnosis and treatment technology and the enrichment of evidence-based medicine evidence, the contents of these guidelines are also constantly updated.scuziumab is an all source monoclonal antibody targeting to inhibit IL-17A, which has been approved for the treatment of as in China.although its application in the field of as treatment in China has just begun, in foreign countries, sikuqiyoumab has been in the treatment of as for several years, with a number of clinical studies and real-world data, and gradually emerging in the guidelines.in this issue, we specially invite Professor Zhu Ping, a military doctor of the air force, from Beijing hospital to interpret and discuss with us the recent diagnosis and treatment guidelines on as and the recommended status of IL-17A inhibitor / skujiumab in authoritative literature. Get up and understand it! In 2015, as a therapeutic drug for psoriasis, it was approved by FDA. In November of the same year, the European Commission (EC) approved it for treatment of as and psoriatic arthritis (PSA).in 2016, in the management guidelines for axial spondyloarthritis (axspa) published by ASAS / EULAR [1], patients with as who are still at disease activity after NSAIDs treatment and patients who fail TNF inhibitor (tnfi) treatment can choose IL-17 inhibitors for treatment (A-level Recommendation / evidence level 1b, figure 1).this is the first step in the promotion of IL-17 inhibitors in the international authoritative guidelines.Figure 1: recommendations for IL-17 inhibitors in ASAS / EULAR guidelines; Figure 2: recommendations for the overall treatment of axial spondyloarthritis in ASAS / EULAR guidelines. With the continuous improvement and accumulation of evidence-based medical evidence, in early 2016, the US FDA approved the use of scuziumab in the treatment of active as patients.in 2019, in the guidelines for the treatment of as and radiologically negative axial spondyloarthritis (NR axspa) released by ACR combined with SAA [2], it is strongly recommended that scuziumab should be used in patients with as who are still active after NSAIDs treatment (Fig. 3), and there is a taboo against tnfi or the first tnfi For patients with poor response to treatment, it is recommended that patients with poor response be treated with skovuximab conditionally, and the degree of recommendation is stronger than that of tolfatib.Figure 3: recommendations for treatment in the updated guidelines for ACR combined with SAA Figure 4: recommended treatment strategies for active as and stable as (SEC: scuziumab; TOF: tolfatinib) in the updated guidelines for ACR combined with SAA In terms of the recommended course of treatment cases, scuzibizumab has rapidly emerged in the international guidelines ⻆ in Europe, it was listed, and then it was recommended in the EULAR guidelines; ⽽ in the United States, with the continuous accumulation of evidence-based medical evidence, scuziumab also made its debut in the ACR in 2019 In the list recommended by the guideline, the clinical recommendation for the first time was second only to tnfi.however, the efficacy of scuzibizumab in the treatment of as is internationally recognized and promising.2 it has been widely used, and it has been recommended by regional guidelines, and one of the most famous ones in the international authoritative guidelines, has gradually been included in the recommended treatment cases of various regional guidelines.in the relevant guidelines issued by the National Institutes of health and clinical optimization (NICE) in 2017 [3], it is recommended that patients with active as who have poor response to conventional NSAIDs or tnfi therapy should be treated with scuziumab (Fig. 5).Figure 5: recommendations of the NICE guidelines on the use of scuziumab in the treatment of as. In 2018, the SFR published the recommendations for the management of spinal joints [2], which also recommended that spa * patients who are still active after NSAIDs treatment should consider tnfi or IL-17 inhibitors (Fig 6) In addition, for patients with active peripheral joint and / or attachment point inflammation after routine treatment, the guidelines suggest that the use of a preparation of drugs (tnfi, IL-23 or IL-17 inhibitors) should be considered for treatment.Figure 6: recommendations of the SFR guidelines for the treatment of as. In the guidelines published by the Taiwan Society of Rheumatology [5], IL-17 inhibitors and tnfi were recommended as treatment cases after the failure of conventional treatment (Fig. 7). at the same time, the guidelines also point out that although tnfi is often used to initiate treatment in pre clinical practice, in some cases, IL-17 inhibitors may be better initial treatment strategies: for example, tuberculosis and HBV reactivation are the main problems in tnfi treatment, and the IL-17 inhibitor sikuqiyumab has a lower risk. however, the basis for selecting a better initial treatment strategy still needs to be further confirmed by real-world safety data. Figure 7: recommendations for the treatment of axial spondyloarthritis in the guidelines of Taiwan Society of rheumatology. With more and more regional guidelines recommended, scuziumab will be applied in more groups. ⼀⽅⾯⾯⼴⼴⼴⼴⼴⼴⼴⼴⼴⼴⼴⼴⼴⼴⼴⼴⼴⼴⼴⼴⼴⽅⾯⼀⽅⾯⼀⽅⾯, which is conducive to obtain and accumulate more evidence about the treatment of SCU. 3 Lancet: IL-17 inhibitors become the choice of biological agents line therapy. In 2017, Professor Joachim sieper, former president of ASAS, and Denis poddubnyy, Professor of Charlotte Medical Sciences in Berlin, Germany, published a review on axspa in the lancet, a top international medical journal [6]. In Chapter , it is proposed that NSAIDs are line therapy and preparations are line therapy in holistic therapy. ⽽ IL-17 inhibitor is a new choice in the treatment of axspa *, and experts recommend that it and TNF inhibitor are both the line treatment options of axspa * (Fig. 8). figure 8: treatment suggestions for axial spondylitis published in the lancet expert review 4 Summary: there are many talents emerging in the field of pharmaceutical preparations, and various targeted drugs are taking care of their own skills and competing to make breakthroughs. in the past, tnfi was the only alternative preparation in the field of as treatment. With the gradual deepening of our understanding of the disease and the understanding and development of drug targets, IL-17A inhibitors are on the stage. with the gradual enrichment of evidence-based medicine evidence and the continuous accumulation of clinical experience, we have seen many benefits for as patients. as a new choice for the treatment of as, the status of IL-17A inhibitor scuziumab in the international guidelines is only slightly weaker than that of tnfi. In some local guidelines and authoritative publications, both IL-17 inhibitor and tnfi are the first-line drugs in the treatment of pharmaceutical preparations. we are looking forward to bringing more benefits and surprises to as patients in China. Professor Zhu Ping commented that as is a chronic inflammatory disease with high disability rate. Patient education, proper exercise and drug treatment are all important treatment methods. in the past 10 years, the application of biological agents has helped more patients achieve standard treatment. IL-17A inhibitor is a biological agent with a new mechanism. It can reduce bone destruction and new bone formation in the process of inflammation and inflammatory repair by inhibiting the proinflammatory activity of inflammatory cytokine IL-17A. in recent years, with the continuous improvement of evidence-based medical evidence and real-world data, the recommendation of IL-17A inhibitors by international authoritative guidelines has been strengthened. in the latest guidelines for the treatment of as and NR axspa issued by ACR combined with SAA in August 2019, it is recommended to use IL-17A inhibitors in patients with as or NR axspa with poor control of NSAIDs. NSAIDs are poorly controlled and tnfi contraindication or tnfi treatment (3-6 months) are still active as or NR axspa patients, so it is recommended to use IL-17A inhibitors. from the changes of the guidelines, it can be seen that the status of IL-17A inhibitors in spa treatment is constantly improving, and the recommended level is consistent with that of TNF inhibitors, and it has gradually become the first-line choice of biological agents. it is hoped that with the continuous improvement of real-world data, IL-17A inhibitors can benefit more patients. * Note: the approved indication of sikuqiyoumab in China is ankylosing spondylitis (as). Professor Zhu Ping, chief physician, Professor, doctoral supervisor, post doctoral instructor, senior expert of Air Force Military Medical University. director of the Institute of Rheumatology and immunology of the PLA, and director of the individualized medical research institute of the National Center for molecular medicine translational sciences. he is also the vice chairman of clinical immunology branch of Chinese society of immunology and chairman of Shaanxi Branch, chairman of rheumatism and molecular immunology branch of National Health Industry Enterprise Management Association, and chairman of rheumatic immunologist branch of Shaanxi Medical Doctor Association. outstanding young and middle-aged technical experts of the former general manager and the winner of the "Silver Award" and "Chinese doctor Award" of Military Education Award are entitled to the special allowance of the State Council. he has successively undertaken more than 30 national level projects, such as national "973", national "863", major special projects, National Science and technology funds, and military key / major projects. it has won the second prize of national science and technology progress award, the first and second prize of provincial and ministerial level, 9 invention patents authorized, more than 200 professional papers published, 96 postgraduates and 3 postdoctoral students trained. refer to [1] van der Heijde D, et al.Ann Rheum Dis. 2017 Jun;76(6):978-991.[2] Ward MM, et al. Arthritis Rheumatol. 2019 Aug 22.[3] NICE. Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors. [4] Wendling D,et al.Joint Bone Spine. 2018 May;85(3):275-284.[5] Wei JC, et al. Int  J  Rheum  Dis.  2020  Jan; 23 (1) 7-23. [6] sieper J, et al. Lancet. 2017 Jul 1; 390 (10089): 73-84 this content is only for medical professional ⼠ reading reference. - end love me!