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)