TNFi Treatment Ineffective for Some Patients with Ankylosing Spondylitis


According to Ankylosing Spondylitis News, a recent study has found that TNF inhibitors are often not effective treatments for patients with ankylosing spondylitis. Read the full study in BMC Rheumatology.

Ankylosing Spondylitis

Ankylosing spondylitis (AS) is part of a group of diseases called spondyloarthropathies. It causes inflammation in the joints, particularly in the pelvic bone, base of the spine, hips, shoulders, and knees. In nearly half of patients with ankylosing spondylitis, patients also experience ocular inflammation.

Gene variants like HLA-B27 may contribute to the development of AS. Normally, HLA-B plays a large role in immune function. HLA, human leukocyte antigen complex, helps the immune system figure out what proteins are created by the body and which are the cause of viruses or bacteria. Other genes, like IL1AIL23R, and ERAP1 have also been linked to AS, although there is no definitive cause. Learn more about ankylosing spondylitis here.

Research Findings

NSAIDs and TNF inhibitors are normally used to treat patients with ankylosing spondylitis. Tumor necrosis factor (TNF) inhibitors are medications that treat inflammatory disorders, explains the American College of Rheumatology. Patients with rheumatic conditions such as psoriasis, ankylosing spondylitis, rheumatoid arthritis, and ulcerative colitis often have higher levels of TNF in their blood. TNF inhibitors help block excess TNF from the blood, thus reducing inflammation and other symptoms. Learn more about TNF inhibitors here.

But a previous study in Arthritis & Rheumatology highlighted that up to 22.5% of patients with AS stopped TNF inhibitor treatment within a year based on either no response or adverse reactions.

This most recent study explored TNF inhibitor treatment for 2,795 patients in 18 countries. A majority of the patients received one TNFi treatment prior to the study, though 9.2% of patients had received two or more treatments.

Researchers wanted to understand the efficacy of TNFi treatment, how often it failed, and how TNFi treatment intersected with productivity, daily function, and quality of life. In this case, treatment was considered a failure if a patient’s ankylosing spondylitis had stayed the same, got worse, or if a physician was not satisfied with disease progression over a period of 3+ months.


A majority of patient responses showed that they switched treatments based on:

  • The TNFi not working
  • No remission
  • No pain reduction
  • Worsening of disease progression

For patients that had more than one TNFi treatment, it became less effective over time. So their third treatment failed much more often than the first treatment.

Additionally, patients whose treatments did not work experienced a lower quality of life, as well as worse physical and mental health. They had more difficulty upholding their work responsibilities, but also more difficulty handling daily life. As such, doctors should consider prescribing and researching additional treatment options.

Jessica Lynn

Jessica Lynn

Jessica Lynn has an educational background in writing and marketing. She firmly believes in the power of writing in amplifying voices, and looks forward to doing so for the rare disease community.

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