In this section we have compiled numerous, informative resources regarding a new class of medications for AS and related diseases: The Biologics, TNF-a Inhibitors. These medications include Enbrel® (entanercept), Remicade® (infliximab) and Humira® (adalimumab). All three have been approved by the FDA for treatment of AS.
-Q&A Regarding the TNF-a Inhibitors- -Patient Assistant Programs- -News Articles- -Links to Other Online Resources-
Q&A Regarding the TNF-a Inhibitors
Once the fusing begins, is there a way to stop it or slow it?
John D. Reveille, MD, responds: The TNF-a blockers being used in AS seem to stop or slow radiographic progression in many AS patients. The problem is that they are expensive and we do not yet have long-term data on the safety profile. There are now international guidelines that we are using not only to help determine who needs the drug, but also who is most likely to benefit from the drug. We are trying to implement those with our 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.
John D. Reveille, MD, responds: Right now, we are restricting them for patients who adhere to the New York modified criteria for AS (diagnostic confirmation criteria for AS). A one-page test called the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), which can be found on the SAA web site, scores an average on six scales between 0 and 10. A person needs to score a 4 on this on average, have active disease for at least four weeks, and have failed at least two NSAIDs. Of course, the usual contra-indications must be taken into account (chronic infections such as tuberculosis, cancer, or other rheumatic disease such as lupus). With the use of TNF-a blockers, the BASDAI in most patients will improve; however, if the treatment hasn’t worked within six to twelve weeks, then it most likely will not work. Bottom line: TNF-a blockers are very expensive, they work, but not every one with AS needs them.
Paul M. Peloso, MD, responds: We know that exercise, physical therapy and NSAIDs work fine for some people. We don't know exactly what the percentage is, but it might be as high as 50%. In addition, the TNF-blockers are very expensive, and they have potential side effects. So the real issue is, if you don't need them, why take them?
What are the most serious potential side effects of the TNF-blockers?
Paul M. Peloso, MD, responds: The main side effect we see on a regular basis is increased infections. We need to test for TB before we use TNF-blockers, and we need to treat TB if a patient has it. There is a risk of increased sinus infections, bronchitis and pneumonia. Other issues that are still being investigated are the risk of lymphoma, congestive heart failure and multiple sclerosis. We are still trying to figure out how important those things are after TNF-blockers.
Question: I am considering being treated with one of the TNF-a inhibitors, and I was wondering what might happen to someone who has undetected pre-cancerous cells of the prostate, cervix, or anywhere else in the body where it may take a long time for cancer to show up. Has anyone talked about this, or are patients automatically pre-tested for these conditions before starting the TNF medications?
For information on this subject (and other questions regarding possible side effects), we suggest you visit the National Institute of Health web pages on the TNF-a Inhibitors:
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Patient Assistance Programs
Although the TNF-a inhibitors have shown very promising results in some people with AS, not everyone has access to them. There are programs that may be able to help.
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Excerpt: "Enbrel, Humira and Remicade are biologics or biologic response modifiers (BRM), Biologics got their name because they are made biologically from living cells..." Click here to view the issue in our Spondylitis Plus archive in the Member Area. Not a member?Then Click here to join!
FDA Approves Remicade ® for Psoriatic Arthritis
Understanding the role of biologic medications in AS
Long Term Safety Data on the Biologics: Enbrel, Remicade
Enbrel and Remicade News
FDA Approves REMICADE for Patients with Ankylosing Spondylitis
The Latest on Remicade® (Infliximab) in the Treatment of Ankylosing Spondylitis
The Biologic Era: New Interest & Treatments in Spondylitis
Anakinra for Treating AS
Predicting an AS patient’s response to TNF-a treatment
FDA accepts supplemental biologics license application (sBLA) for Remicade® to treat AS
Determining who receives TNF-a therapy for Ankylosing Spondylitis
Weekly etanercept might replace twice-weekly doses
Patients on TNF inhibitors “concealing” adverse effects?
The Effect of tumor necrosis factor on the response of pneumococcal vaccination in patients with rheumatoid arthritis ankylosing spondylitis
Links to Other Online Resources
The TNF Superfamily of Cell Regulators
Want to read some of the detailed science behind the tumor necrosis factor, or TNF? If so, here is a link to a PDF file that explains it in depth: The TNF superfamily regulate a variety of immune and developmental events