Biologic Drugs for Ankylosing Spondylitis
When over-the-counter medications aren't enough, your doctor might prescribe a class of drugs known as biologics to treat ankylosing spondylitis.
By Madeline R. Vann, MPH
Medically Reviewed by Cynthia Haines, MD
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Ankylosing spondylitis patients often take "non-steroidal anti-inflammatory" medications to control their pain. However, there's another drug class called "biologics" that can also effectively reduce discomfort.
Biologics treat stiffness, pain, and inflammation, and early research suggests that these medications could also reduce blood vessel damage and protect against certain types of heart disease. Biologics block the protein TNF, or tumor necrosis factor, which plays a role in the immune response. So far, four biologics have been cleared for the treatment of ankylosing spondylitis. These drugs include: infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), and golimumab (Simponi).
Doctors usually prescribe biologics after three months of unsuccessful treatment with non-steroidal anti-inflammatory (NSAIDs) medications. Those with mild ankylosing spondylitis (AS) can take NSAIDs for pain, but others have damaged joints and should reassess the effectiveness of their treatment.
"If I already see they've had erosion of the sacroiliac joints, that tells me the disease is going to progress," says Beth Jonas, MD, a rheumatologist, associate professor of rheumatology at the Thurston Arthritis Research Center at the University of North Carolina School of Medicine in Chapel Hill. "TNF inhibitors are remarkably more effective than the anti-inflammatories," she adds.
TNF inhibitors do not cure AS, and it's not known whether these biologics actually slow down the disease's progression. "We can't predict when we see a patient at baseline how severe their disease is going to be," Dr. Jonas says. "What we do know is that the TNF inhibitors will control inflammation and control signs and symptoms."
TNF Blockers: Possible Side Effects
TNF blockers increase risk of infection, and reactivation of tuberculosis is a possibility. More research is needed to understand the risk for certain cancers, such as lymphoma. "We have data from people who have been on them for 10 or 15 years," Jonas says, but the effects after 20, 30, or more years aren't well understood.
Anti-TNF drugs aren't recommended if you have certain medical conditions, such as multiple sclerosis or lupus. Make sure your doctor knows your entire health history before you start on one of these drugs.
TNF Blockers: AS Treatment Plan
TNF inhibitors require regular shots or infusions and are expensive if not covered by your medical insurance. The dosage and treatment schedule depends on your disease status and how well you have responded to other medications. Here are a few plan options:
- Enbrel for AS (etanercept):25 to 50 milligrams (mg) once or twice a week, given as an injection
- Remicade for AS (infliximab):3 to 6 mg/kg given by infusion on a schedule determined by your doctor
- Humira for AS (adalimumab):40 mg given two to four times a month by injection
- Simponi for AS (golimumab):50 mg given once a month by injection
TNF Blockers: Care Strategies
Discuss the possible side effects of TNF blockers with your doctor, and follow these simple steps to stay healthy while on the medication:
- Avoid infections:TNF inhibitors work by changing your body's immune response. As a result, you'll be at an increased risk for infections. Do your best to avoid contact with people who have a cold or the flu. If you do get sick, alert your doctor immediately.
- Protect your skin.Because of a higher risk for skin cancer, protect your skin from sun exposure as much as possible.
- Stick to your checkup schedule.Regular doctor visits are important if you're on biologics – even if you feel great. "At least every six months, check in with your rheumatologist to make sure you're not having any side effects and make sure the medicine is doing what we want it to be doing and not causing any harm," Jonas says.
- Don't smoke.Smoking quadruples your risk for severe joint damage with ankylosing spondylitis and could undo any benefit from taking the medications.
Video: 2. What is a Biological and how does it help my Ankylosing Spondylitis.
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