Anti TNF therapy

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.

The five anti TNF drugs licensed by the European Medicines Agency for the treatment of AS are:

adalimumab (Humira)

  • Approved by NICE for use in AS
  • Licensed for use in non-radiographic axial spondyloarthritis 
  • Suitable for people with Crohn's disease
  • Can help reduce the severity and frequency of uveitis attacks
  • Self administered by an injection pen device once fortnightly

certolizumab pegol (Cimzia)

  • Not yet been reviewed by NICE but likely to be available in many rheumatology departments
  • Licensed for AS and non-radiographic axial spondyloarthritis
  • Self administered by a pre-filled syringe once fortnightly

etanercept (Enbrel)

  • Approved by NICE for use in AS
  • Not approved for Crohn's disease
  • Self administered by an injection device once or twice a week
  • Also available in a pre-filled syringe

golimumab (Simponi)

  • Approved by NICE for AS
  • Not approved for Crohn's Disease
  • Self administered by an injection device once monthly

infliximab (Remicade)

  • Not approved by NICE for AS on the grounds of cost
  • Administered in an out patients clinic by an infusion (drip) every 8 weeks

Who can have anti TNF therapy?

Many people with AS do not need anti TNF therapy because they are managing well on medications such as NSAIDs along with physiotherapy.

If you have been through a range of different therapies, are in pain and your AS is really having a negative impact on your life then do ask your rheumatologist at your next appointment if they think you are eligible and suitable for anti TNF therapy.

Remember that only consultant rheumatologists can prescribe anti TNF therapy. Your GP cannot offer it to you. So if you are not under the care of a rheumatologist do ask your GP to refer you.

If you want to see a rheumatologist but aren't sure where you should go then you can always call Sally Dickinson on the Helpline.

For more details you can look at the full NICE guidelines. You can also look at a quick reference guide and a version aimed at patients.

Will anti TNF therapy work for me?

The evidence shows that anti TNF therapy works in around 8 in 10 AS patients and the benefits do not seem to wear off over time. There is no proof as yet that anti TNF has a positive impact on radiographic (x-ray) progression of the condition or that it can prevent new bone formation.

People get best results from anti TNF therapy when they use it alongside a daily stretching and exercise routine.

Anti TNF therapy usually stops working when you stop taking it. On average people relapse within 14 weeks of stopping therapy. The main reasons for having to stop therapy are:

  • Deciding to start a family
  • Surgery
  • Serious infections

If you need or plan to stop treatment temporarily for any reason, it is important to plan and discuss this with your consultant well in advance.

What are the risks and side effects?

Anti TNF therapy has relatively few side effects. The most common are injection site reactions and minor infections.

As yet the long term side effects and risks of anti TNF therapy are not fully understood because they are still a relatively new treatment, however there is now over 10 years experience of using these treatments in patients with other types of arthritis and no pattern of serious long term side effects is emerging. Safety data is being collected by in large registries around the world, principally the UK, (British Society for Rheumatology Biologics Register), mainland Europe and Scandinavia.

Last reviewed: May 2014

 

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