NICE approved biologics
In 2014 The Department of Health asked the National Institute for Health and Care Excellence (NICE) to produce guidance on using anti TNF therapy for AS and non radiographic axial spondyloarthritis. NASS previously worked with NICE on the appraisal for the anti TNF drugs back in 2008. This gave people with AS access to adalimumab (Humira) and etanercept (Enbrel). We worked with NICE again in 2011 when another anti TNF golimumab (Simponi) was approved for AS.
Under the current NICE anti TNF guidance:
All the available anti TNF therapies are recommended as options for treating ankylosing spondylitis (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 ankylosing spondylitis (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, but 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.
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.
Secukinumab (Cosentyx) for ankylosing spondylitis (AS)
NICE published Guidance
in 2016 recommending secukinumab as an option for treating active AS in adults whose disease has responded inadequately to conventional therapy (non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors).