Biologics in Ankylosing Spondylitis – any myths?

Biologics are already widely use in treating ankylosing spondylitis, are there any myths? Of course there are.
Biologics aren’t a cure for ankylosing spondylitis, these drugs reduce symptoms and pain. Not all biologics work in ankylosing spondylitis or aren’t approved. TNF-alpha inhibitors like Enbrel, Remicade, Humira, and Simponi are approved by FDA and EMEA. Tocilizumab, an IL-6 inhibitor, and rituximab, a monoclonal antibody against CD20, have both been reported to be effective, but studies are still under way and these drugs aren't yet approved for the treatment of ankylosing spondylitis. A pilot study on efficacy of Orencia in ankylosing spondylitis hasn’t been promising, as the BASDAI didn’t change significantly. Anakinra had shown some efficacy in a pilot study, but failed to improve in later studies, and isn’t currently used for this indication.
Sometimes symptoms like pain and morning stiffness improve dramatically. I recall someone telling me, he woke up the night after the infusion, because something was unusual, and the unusual thing has been: he was free of pain.
Even if improvement is fantastic, some people can’t take biologics because of adverse events or concomitant disease. And let’s not forget the problem of non-responders. What about long term effects of blocking TNF-alpha? How about development of cancer/leukaemia under therapy? There are quite a lot questions that are still discussed.

Corrected: Tocilizumab, an IL-6 inhibitor, and rituximab, a monoclonal antibody against CD20, have both been reported to be effective, but studies are still under way and these drugs are approved for the treatment of ankylosing spondylitis. // Sorry, these two drugs aren't approved. Corrected 15.06.2012

Some further additions concerning IL-6: A Study of RoActemra/Actemra (Tocilizumab) in Patients With Ankylosing Spondylitis Who Have Failed Treatment With NSAIDs http://clinicaltrials.gov/ct2/show/NCT01209702  This study has been suspended. Dr. shashank akerkar ‏@doctorakerkar Anti IL6 does not seem to have a role in ankylosing ‪#spondylitis‬ ‪#EULAR2012 https://twitter.com/doctorakerkar/status/210652794112327680


15.06.2012