In patients with AFRS
It was noted that at the current time there is insufficient evidence to
support effectiveness, and therefore trials must demonstrate that
biologics are effective in this cohort and to determine whether this
requires surgery to be performed in parallel. However, providing these
criteria are met by future research, the following conditional
recommendations could be made;
Biologics should NOT be considered if the patient not had previous
surgery
Biologics should NOT be considered if the patient has not used oral
corticosteroids in the preceding 12 months
Biologics should NOT be considered if the patient has required 1 - 2
courses of oral corticosteroids in the preceding 12 months AND has not
undergone previous surgery or has undergone one previous surgery.
Biologics should be considered if patients have required at least 1
course of steroids in the last year or are unable to take OCS AND have
had 3 or more previous surgeries or are unfit for surgery
Biologics should be considered if patients have received 2 or more
courses of OCS, or are unable to take OCS AND have had 2 or more
surgeries, or are considered unfit for surgery (under local or general
anaesthetic)