Is TNF Inhibitor Treatment Necessary for Ankylosing Spondylitis Patients in Remission?

According to a story from The Rheumatologist, a common treatment method for ankylosing spondylitis, a form of rare arthritis the affects the sacroiliac joints and spine, is a class of drugs called tumor necrosis factor (TNF) inhibitors. While these treatments can offer significant benefits for patients, they can also be expensive and there is also potential for harmful long-term side effects. With these considerations in mind, is it necessary for patients that are in remission to continue their use?

About Ankylosing Spondylitis (AS)

Ankylosing spondylitis is a rare form of arthritis which is characterized by long term inflammation of the spinal joints. Other joints may also be affected. The precise cause of ankylosing spondylitis has not been identified. A host of environmental and genetic factors may play a role; for example, a study found that the majority of patients in the UK presented with the HLA-B27 antigen. The onset of ankylosing spondylitis symptoms often begins in early adulthood. These symptoms may include relapsing/remitting back pain, progressive joint stiffening, fatigue, fever, and weight loss. Inflammation can spread to other parts of the body, such as the eyes, the cardiovascular system, and lungs. No cure for the disease exists, so treatment focuses on pain management and slowing disease progression. Treatment may include NSAIDs, opioids, TNF inhibitors, physical therapy, surgery, and some others. Unfortunately, most therapies can cause serious side effects with long term use. To learn more about ankylosing spondylitis, click here.

TNF Inhibitors: Reducing Dose vs Halting Treatment

Most research appears to indicate that it is safe for patients to reduce their dose if they have achieved long term remission; however, complete cessation of treatment is not recommended. However, there aren’t necessarily any standards for how long a patient should be in remission or to what extent the dose should be reduced. A Spanish study from earlier this year indicated that a smaller dose was no less effective than the standard for patients that were in remission. These patients were also at a reduced risk of adverse events, but it was unclear why some patients appeared to benefit while others didn’t.

While reducing dose may be useful for patients in remission, study findings suggest that halting treatment is a much riskier decision; many patients will experience relapse eventually and even when treatment is reintroduced, they do not always have as good of a response.

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