Anti TNF therapy is changing the way AS is managed
In people with AS, along with some other forms of inflammatory arthritis, a protein called tumour necrosis factor (TNF) is over-produced in the body. This causes inflammation and damage to bones, cartilage and tissue. Anti TNF therapy blocks the action of TNF and can reduce inflammation.
In February 2016, The National Institute for Health and Care Excellence (NICE) published updated guidance for the use of anti TNF therapy. Known as TA383, these guidelines make a number of recommendations.
- All the available anti TNF therapies are recommended as options for treating AS
This means you and your rheumatologist can choose any of the anti TNF therapies on the market, including infliximab (cheapest version). Previously infliximab was not available to people with AS on the grounds of cost. NICE recommend the choice of treatment should be made after discussion between the rheumatologist and the patient about the advantages and disadvantages of the treatments available.
- Adalimumab (Humira), certolizumab pegol (Cimzia) and etanercept (Enbrel) are recommended, as options for treating severe non-radiographic axial spondyloarthritis
This means that anti TNF therapy can now be used earlier. The previous guidance specified that people needed a diagnosis of AS, where changes to the sacroilliac joints and /or the spine could be seen on x-ray. This left some people living in pain as they had all the symptoms of AS, but they did not have changes on x-ray. Now the guidance includes people with non-radiographic axial spondyloarthritis which is where no changes are yet visible on x-ray. If you have previously been told that your x-ray or MRI results don't meet the criteria for you to go onto anti TNF therapy, it may be time to ask again.
- Treatment with another anti TNF is recommended for people who cannot tolerate, or whose disease has not responded to, treatment with the first TNF-alpha inhibitor, or whose disease has stopped responding after an initial response
Until now, NICE guidance only allowed people to try one anti TNF, unless they had side effects in the first 12 weeks. If the first anti TNF didn't work or if effectiveness wore off over time, NICE did not recommend trying another anti TNF.
Now your rheumatologist can think about trying you on another anti TNF if your first anti TNF didn't work or if the effect has worn off over time.
The following anti TNF drugs are licensed by the European Medicines Agency for the treatment of AS. Cimzia, Enbrel and Humira are also licensed for the treatment of non radiographic axial spondyloarthritis.
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