ASAS Definition of Difficult-to-Manage Axial Spondyloarthritis - ASAS D2T SpAM


Despite the availability of several potent anti-inflammatory treatment options, only about 40 to 50% of patients with axial spondyloarthritis (axSpA) achieve the ASAS40 response and even lower proportion of patients (approximately 10-20%) achieve remission or inactive disease activity state within 16 to 24 weeks of treatment according to the data from randomized controlled trials with b- and tsDMARDs. There are several potential reasons for the non-response or partial response in axSpA, which can be related to the disease itself, but could also be related to factors other than biological non-response (e.g., chronic pain syndrome, concomitant degenerative disease, etc.).


Within the ASAS D2M SpA initiative we aim to develop a consensus definition of a difficult-to-treat axSpA that is primarily related to the biological nonresponse, i.e., active disease despite sufficient anti-inflammatory treatment. The definition is intended for clinical research focusing on characterization of those patients, identification of the mechanisms beyond the refractory disease and conducting interventional trials.


The project will include the following steps:

  • Literature review to identify potential elements or existing definitions of D2M SpA.
  • Online survey among ASAS members related to the potential elements of the definition of a D2M SpA.
  • Development of the first draft of the definition based on the survey results by the steering committee.
  • Meeting of the task force with discussion of the proposed definition, amendments, development of the final version and voting.
  • Presentation of the final definition at the ASAS annual meeting and endorsement.

Timelines of the project: 2022 – ongoing

Project Team

PI: Denis Poddubnyy, Désirée van der Heijde

Steering committee:

Xenofon Baraliakos

Victoria Navarro Compan

Désirée van der Heijde

Denis Poddubnyy


Murat Torgutalp

Working group:

Suzanne Arends
Sibel Aydin
Simone Battista
Filip van den Bosch
Christine Bundy
Alberto Cauli
Maxime Dougados
Tuncay Duruöz
Bassel El-Zorkany
Warren Fong
Floris van Gaalen
Rodrigo Garcia Salinas
Marco Garrido Cumbrera
Pál Géher
Lianne Gensler
Carla Goncalves
Simeon Grazio
Feng Huang
Mitsumasa Kishimoto
Robert Landewé
Katy Leung
Jo Lowe
Pedro Machado
Helena Marzo-Ortega
Bhowmik Meghnathi
Anna Molto
Elena Nikiphorou
Sofia Ramiro
Martin Rudwaleit
Alexandre Sepriano
James Wei