An update on the use of tumor necrosis factor alpha inhibitors in the treatment of ankylosing spondylitis

ABSTRACT

Introduction: Ankylosing spondylitis is a chronic immune-mediated disease affecting the sacroiliac joints and the spine manifesting with new bone formation and osteopenia. Over the past decade, tumour necrosis factor alpha (TNF-α) inhibitors (TNFi) have become the cornerstone for therapy in improving functional outcomes, and decreasing disease activity in patients with a marginal benefit from non-steroidal anti-inflammatory (NSAID) therapy. At this time, it remains to be determined whether these agents decrease new bone formation, although some studies have recently suggested that.

Areas covered: In this review we discuss the factors that favour a good response to these agents both initially and during maintenance, and some of the more recent studies outlining strategies for dose reduction.

Expert commentary: Finally, we discuss the importance of using more objective tools for disease activity, such as magnetic resonance imaging, as a complementary tool for clinical assessments in both predicting responses to treatment but also in selecting patients most suited for targeted therapy.

KEYWORDS:

• Ankylosing spondylitis
• axial spondyloarthritis
• TNF alpha inhibitors
• new bone formation
• biological agents
• infliximab
• etanercept
• adalimumab
• certolizumab
• golimumab

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

WP Maksymowych has received honoraria and/or research grants from Abbvie, Amgen, Boehringer, Celgene, Eli-Lilly, Janssen, Merck, Pfizer, Sanofi and UCB.