The TNF-a Inhibitors, biologic medications such as Enbrel®, Remicade® and Humira®, have been recognized in the last few years as the latest and possibly best treatment for ankylosing spondylitis in some people - especially those with moderate to severe disease.

Many studies have been done on these medications investigating their efficacy, safety and other aspects. One of the larger focuses has been whether these medications can slow or even halt the progression of ankylosing spondylitis, especially in terms of spinal fusion. Note that the structural changes can take a long time to occur, and can take 7-10 years to be severe enough to show up on x-ray.

When asked if there was any way to stop the fusion once it had begun during an educational seminar in Orlando in 2004, Dr. John D. Reveille responded, "The TNF-a blockers being used in AS seem to stop or slow radiographic progression in many AS patients…That is the only treatment that we are aware of right now that appears to stop the fusion, and whether or not they continue to work over time, remains to be seen."

Much concern was voiced on the Spondylitis Association of America message boards over the results of a recent study involving a mouse model of ankylosing spondylitis whose authors concluded that treatment with a TNF-a Inhibitor "did not affect the severity and incidence of joint ankylosis in a mouse model of [spondylitis]." Click here to read the story regarding said study, and click here to view the discussion on the forums.

The May, 2007 issue of the journal, Current Opinion in Rheumatology, contains a review of literature and studies published on the TNF-a Inhibitors that examines their efficacy. The review surmises that, "the data suggest a benefit, at least in the short term", especially in terms of significantly reducing spinal inflammation. Although the review, entitled, "New therapeutic approaches for spondyloarthritis", does state that there is "insufficient evidence to conclude definitely" that the TNF-a Inhibitors slow or stop the fusion associated with the disease.

The review also suggest that when patients are diagnosed early and offered TNF-a Inhibitor that the therapy may "arrest and prevent structural disease progression". However, only longer-term studies with large enrollments will be able to determine this.

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