Please note that this list is not exhaustive, but is intended to be used as a general guide. We advise discussing benefits and risks of all prescribed medications, including any FDA “boxed warnings,” with your doctor. Please do not start or stop a medication without first speaking with your doctor. Finally, tell your doctor about all prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other physicians.
| Trade Name | Generic Name | Pill Dose and Frequency | Long Acting Formulation Dose and Frequency | Usual Dose | Maximum Daily Dose | Prescription Required? | FDA Approval for Ankylosing Spondylitis | Special Circumstances for use |
|---|---|---|---|---|---|---|---|---|
| Indocin | Indomethacin | 25-50 mg 3-4×/day | 75 mg ER 2×/day | 75 mg ER 2×/day | 150-200 mg | Yes | Yes | Continuous use may reduce spinal fusion. |
| Naprosyn | Naproxen | 250-500 mg 2×/day | 500-750 mg 1×/day | 500-750 mg 1×/day | 1000 mg | Yes | Yes | Vimovo© (esomeprazole/ naproxen combo) for NSAID stomach intolerance. |
| Aleve | Naproxen | 220 mg 2×/day | N/A | 440 mg 2×/day | 880 mg | No | N/A | |
| Voltaren | Diclofenac | 25, 50 mg 2-4×l/day | 100 mg ER 1-2×/day | 75 mg DR 2×/day | 200 mg | Yes | Yes | Arthrotec©(diclofenac/ misoprostol combo) for NSAID stomach intolerance. Voltaren gel© cream, Pennsaid© drops topically for peripheral joint pain. Continuous use may reduce spinal fusion. |
| Clinoril | Sulindac | 150, 200 mg 1-2×/day | N/A | 200 mg 1×/day | 200-400 mg | Yes | Yes | |
| Feldene | Piroxicam | 10, 20 mg 1×/day | N/A | 20mg 1×/day | 20 mg | Yes | No | Continuous use may reduce spinal fusion. |
| Lodine | Etodolac | 200, 300, 400, 500 mg 2×/day | 400, 500, 600 mg ER 1-2×/day | 400 mg ER 2×/day | 1000 mg | Yes | No | |
| Mobic | Meloxicam | 7.5, 15 mg 1×/day | N/A | 15 mg 1×/day | 15 mg | Yes | No | |
| Celebrex | Celecoxib | 100, 200 mg 2×/day | N/A | 200 mg 1×/day | 400 mg | Yes | Yes | COX-2 inhibitor has less propensity for stomach ulcers. Continuous use may reduce spinal fusion. |
| Motrin/Advil | Ibuprofen | 200, 400, 600, 800mg 3-4×/day | N/A | 600-800 mg 3×/day | 3200 mg | No | No | Duexis©(famotidine/ ibuprofen combo) for NSAID stomach intolerance. Continuous use may reduce spinal fusion. |
| Relafen | Nabumetone | 500,750 mg 1×/day | N/A | 1000-1500 mg/day | 1000-2000 mg | Yes | No |
| Trade Name | Generic or Brand Name | Dose | Frequency | Total Dose | Route of Administration | FDA Approval for Ankylosing Spondylitis | Special circumstances for use |
|---|---|---|---|---|---|---|---|
| Azulfidine | Sulfasalazine | 500-1500 mg | 2-3x/day | 2000-4000 mg/day | Oral | No. Approved for ulcerative colitis. | Used for peripheral arthritis in AS and related illness. |
| Rheumatrex Trexall Rosuvo | Methotrexate | 7.5-25 mg | One or two divided doses weekly | 25 mg weekly | Oral or subcutaneous injection | No. Approved for seronegative SpA & psoriasis. | Used for peripheral arthritis in AS and related illness; steroid sparing drug for uveitis. |
| Imuran | Azathioprine | 50-100 mg | One or two divided doses daily | 200 mg daily | Oral | No. | Used for peripheral arthritis in AS and related illness; used to manage colitis in SpA. |
| Otezla | Apremilast | 10-30 mg | Divided doses daily | 10-30 mg 2×/day | Oral | No. Approved for psoriasis and psoriatic arthritis. | Used for peripheral arthritis in AS and related illness. |
| Xeljanz, Xeljanz XR | Tofacitinib | 5 mg (AS) 5 mg (PsA) 10 mg (UC) | 2x/day | 10 mg daily (AS) 10 mg daily (PsA) 20 mg daily (UC) | Oral | Yes. Approved for AS, psoriatic arthritis, and ulcerative colitis. | Should only be prescribed when TNFi are not tolerated or response to TNFi is inadequate. |
| Rinvoq | Upadacitinib | 15 mg | 1x/day | 15 mg | Oral | Yes. Approved for AS, nr-axSpA, and psoriatic arthritis. | Should only be prescribed when TNFi are not tolerated or response to TNFi is inadequate. |
| Trade Name | Generic or Brand Name | Dose | Frequency | Total Dose | Route of Administration | FDA Approval for Ankylosing Spondylitis | Special circumstances for use |
|---|---|---|---|---|---|---|---|
| Enbrel (TNF-alpha blocker) | Etanercept | 25-50 mg | Once weekly | 50 mg/week | Subcutaneous injection | Yes. Also approved for psoriatic arthritis and juvenile idiopathic arthritis. | Not effective in colitis associated with AS. Not as effective in iritis associated with AS. May reduce spinal fusion. |
| Remicade (TNF-alpha blocker) | Infliximab | 3-10 mg/kg | Every 4-8 weeks | 200-800 mg every 4-8 weeks | Intravenous infusion | Yes. Also approved for psoriatic arthritis. | Effective for AS patients with co-existing colitis and iritis. Has a mouse protein as part of drug molecule which can cause infusion reactions. May reduce spinal fusion. |
| Humira (TNF-alpha blocker) | Adalimumab | 40 mg | Every 2 weeks | 40 mg | Subcutaneous injection | Yes. Also approved for psoriatic arthritis and juvenile idiopathic arthritis. | Effective for AS patients with co-existing colitis and iritis. May reduce spinal fusion. |
| Simponi (TNF-alpha blocker) | Golimumab | 50 mg | Every 4 weeks | 50 mg | Subcutaneous injection | Yes. Also approved for psoriatic arthritis. | Effective for AS patients with co-existing colitis and iritis. May reduce spinal fusion. |
| Simponi Aria (TNF- alpha blocker) | Golimumab | 2 mg/kg | Baseline, at 4 weeks, then every 8 weeks | 50-150 mg/8 weeks | Intravenous infusion | Yes. Also approved for psoriatic arthritis. | Effective for AS patients with co-existing colitis and iritis. May reduce spinal fusion. |
| Cimzia (TNF-alpha blocker) | Certolizumab pegol | 200-400 mg | Every 4 weeks | 400 mg monthly | Subcutaneous injection | Yes. Also approved for psoriatic arthritis and non-radiographic axial spondyloarthritis. | Effective for AS patients with co-existing colitis and iritis. May have less hematological side-effects. Does not cross placental barrier. May reduce spinal fusion. |
| Cosentyx (Interleukin 17 blocker) | Secukinumab | 150-300 mg | 150 mg weekly × 4 weeks loading dose, then 150 mg every 4 weeks | 150 mg | Subcutaneous injection | Yes. Also approved for psoriatic arthritis and non-radiographic axial spondyloarthritis. | Loading and maintenance dose of 300 mg if there is co-existing moderate to severe psoriasis. New onset of or flare-up of Crohn’s or colitis bears caution. |
| Taltz (Interleukin 17 blocker) | Ixekizumab | 160 mg, then 80. | 160 mg loading dose, then 80 mg every 4 weeks. | 80 mg | Subcutaneous injection | Yes. Also approved for psoriatic arthritis and non-radiographic axial spondyloarthritis. | Used for spinal inflammation & peripheral arthritis in AS. May contribute to new onset of or flare-up of Crohn’s or colitis. |
In addition to the above originator biologic medications, the FDA has approved several biosimilar biologic medications for AS and related diseases. We include them below for informational purposes. Some are not available in the US market as of yet.
Biosimilars for adalimumab (Humira) include:
Biosimilars for infliximab (Remicade) include:
Biosimilars for etanercept (Enbrel) include:
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