by Lauren Taylor from In The Cloud Copy
Spondyloarthropathies is an umbrella term for a group of chronic diseases that affect the joints. These can affect children and adults and include reactive arthritis, psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel disease-related joint problems. Symptoms and outcomes for the various spondyloarthropathies are all different; they all usually have some involvement in the sacroiliac joint, which is the attachment between your pelvis and lower back, as well as affecting joints where tendons and ligaments attach to the bone, like the hips, knees, and feet. The spine is more typically affected in adults, while children generally have more arm and leg involvement. Spondyloarthropathies sometimes lead to a condition called uveitis, an inflammatory eye condition.
Standard Treatment for Spondyloarthropathies
The standard treatment for quite some time for these conditions has been TNF inhibitors. TNF inhibitors work by stopping inflammation and are also called TNF blockers, biologic therapies, or anti-TNF drugs. TNF inhibitors are antibodies that are made from human and/or animal tissue. They work by causing a reaction in the body’s immune system to block the development of inflammation. The immune system typically makes TNF, which stands for tumor necrosis factor. TNF is usually kept at a steady level in the body, but in these autoimmune diseases, the body makes too much TNF and that ultimately leads to inflammation.
Second Line Treatments with IL-17 Inhibition
TNF blockers do remain the gold standard for treatment in spondyloarthropathies; new studies show that adding an IL-17 inhibitor is preferred over the addition of a second TNF blocker when second line therapy is needed. IL-17, or Interleukin-17, is a cytokine that initiates T-cell activation leading to activation of neutrophils. This activation can contribute to the development of inflammatory diseases. Secukinumab (marketed as Cosentyx) and ixekisumab (marketed as Taltz) are two medications in the IL-17 inhibitor category that are recommended treatments as second line therapy.
While these are recommended strongly as second line treatments, new data shows that they may be viable first line treatments in these conditions. Researchers did note that treatment with secukinumab increased fungal infections from candida, as IL-17 typically protects against surface candida. A concern for Crohn’s disease and ulcerative colitis also existed. A flare in these diseases increased in patients taking secukinumab and there was a small percentage of new onset cases.
Additional medications in the IL-17 inhibition category that are showing promising results include entanercept (marketed as Enbrel), as well as golimumab (marketed as Simponi). Bimekizumab is also showing promising results at varying dosing levels.
Further research showed that withdrawing a medication because remission had been achieved would not be recommended, as 41% of patients who had their drug withdrawn failed to achieve remission again after restarting the drug. This serves as a warning about halting a medication altogether just because remission is achieved.
Researchers also touched on the controversy of adding “background” sulfasalazine, methotrexate, or leflunomide in patients being treated with a biologic. Research varies in this area, as some shows that there is a higher drug retention when these medications are used in the “background” while other data does not support that. In this case, more research is still needed, but researchers say it is currently rational to choose to use background medications to increase retention.
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