The 2025 BSR guideline for the treatment of axial spondyloarthritis with biologic and targeted synthetic DMARDs

The 2025 British Society for Rheumatology guideline for the treatment of axial spondyloarthritis with biologic and targeted synthetic DMARDs

Need for guideline update
Pharmacological management has advanced considerably since the previous BSR axSpA guideline to incorporate new classes of biologic DMARDs (bDMARDs, including biosimilars), targeted synthetic DMARDs (tsDMARDs) and treatment strategies such as drug tapering. Therapeutic options for treating EMMs as index conditions have similarly evolved. The increasingly complex therapeutic landscape, with varying efficacy and safety of drugs for each disease manifestation, forms the context in which we aimed to update the BSR guideline for the treatment of axSpA with b/tsDMARDs. The key questions that the guideline sought to answer were published in the guideline scope, including the effectiveness and safety of targeted therapies; switching, combining, tapering or withdrawing targeted therapies; and treating to target. The guideline applies only to adults with axSpA. For brevity, we refer to b/tsDMARDs as “targeted therapies” throughout.

Target audience
This guideline is for health professionals in the UK who directly care for adults with axSpA (including but not limited to rheumatologists, rheumatology specialist nurses, allied health professionals, rheumatology specialty trainees, pharmacists), people living with axSpA and other stakeholders.


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