Spondyloarthritis Medications Overview

Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other physicians. Do not start or stop a medication without telling your doctor. This list is not intended to be exhaustive, but is intended to be used as a general guide.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

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

 

Disease Modifying Anti-Rheumatic Drugs (DMARDs)

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 2-3×/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.
Xeljans Tofacitinib 5 mg for PsA
10 mg for UC
2x/day 10 mg daily for PsA
20 mg daily for UC
Oral No. Approved for psoriatic arthritis, and ulcerative colitis. Is in trials for AS. There is a warning about deep venous clots when taking the higher dose (for ulcerative colitis.)

Biologic Medications

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. 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.
Stelara (Interleukin 12,23 blocker) Ustekinumab 45-90 mg Baseline, at 4 weeks, then every 12 weeks <100 kg 45 mg
>100 kg 90 mg
Subcutaneous injection No. Approved for psoriatic arthritis. Used for spinal inflammation, peripheral arthritis & colitis in AS and related illness.
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. 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. Used for spinal inflammation & peripheral arthritis in AS. May contribute to new onset of or flare-up of Crohn’s or colitis.

Biosimilar Medications:

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.

Biosimilars for adalimumab (Humira) include:

  • • Amjevita (adalimumab-atto). FDA approved in September of 2016.
  • • Cyltezo (adalimumab-adbm). FDA approved in August of 2017.
  • • Hyrimoz (adalimumab-adaz). FDA approved in October of 2018.

Biosimilars for infliximab (Remicade) include:

  • • Inflectra (infliximab-dyyb). FDA approved in April of 2016.
  • • Renflexis (infliximab-abda). FDA approved in May of 2017.
  • • Ixifi (infliximab-qbtx). FDA approved in December of 2017.

Biosimilars for etanercept (Enbrel) include:

  • • Erelzi (etanercept-szzs). FDA approved in August of 2016.
  • • Eticovo (Etanercept-ykro). FDA approved in April of 2019.

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