Biologic Therapy

Discover the role of biologic therapy in managing axial SpA (AS)

This information is for anyone with axial spondyloarthritis (axial SpA) including people with ankylosing spondylitis (AS)

Biologic therapy has changed the way axial SpA (AS) is managed

What is a biologic?

Biologics are made up of genetically-engineered proteins from living organisms and are very large, complex molecules. They work by blocking aspects of the immune system to slow down the attack on your joints and spine.

Unlike medications like paracetamol or ibuprofen, biologic medicines are not manufactured by simply combining specific chemical elements in an ordered process.

Biologic Medicine Pharmaceutical Medicine
Very large and complex medicine Smaller with a less complex structure
Made through a biological process Made through a chemical process
Because they are so large and complex, copies can never be identical. Exact copies can be made by using the same chemical componnts and processes
Copies known as biosimiliars Copies known as generics





When biologic therapy can be used

NICE (National Institute for Health and Care Excellence) say biologic therapy is an option for treating severe active axial SpA (AS) in people who haven’t responded adequately to, or who cannot tolerate, NSAIDs.

What biologics are available?

There are currently two types of biologic therapy which have been licensed to treat axial SpA (AS) and are approved by NICE. We know there are more currently in development and going through clinical trials. Both types work by reducing the inflammation produced by the body.

Anti TNF therapy

Anti TNF therapy is used to treat a range of conditions including non radiographic axial spondyloarthritis and ankylosing spondylitis.

It interferes with the action of a protein called tumour necrosis factor (TNF) which is over-active in the body in people with inflammatory arthritis. This causes inflammation and damage to bones, cartilage and tissue. Anti TNF therapy blocks the action of TNF and can reduce the amount of inflammation being produced in your body.

Anti TNF medications currently available include:

Adalimumab (Humira)

  • Self administered by an injection pen device
  • Once fortnightly dosing

Certolizumab pegol (Cimzia)

  • Self administered by an injection pen device
  • When you start certolizumab pegol you need to do two injections every two weeks for the first 6 weeks. You then move to one injection every two weeks, or two injections every 4 weeks

Etanercept (Enbrel, Benepali and Erelzi)

  • Self administered by an injection pen device or pre-filled syringe
  • Once or twice weekly dosing

Golimumab (Simponi)

  • Self administered by an injection pen device
  • Once monthly dosing

Infliximab (Remicade, Remsima, Flixabi and Inflectra)

  • Administered by an infusion (drip), often in a day unit clinic
  • Dosing varies by individual but is commonly every 6 to 8 weeks

Anti IL 17A

This type of biologic therapy works by neutralising the activity of a protein in the body called IL 17A.

Research shows that people with AS have very high levels of IL 17A in their body compared with the general population. Researchers discovered that IL 17A plays a very important role in causing the inflammation associated with AS. By neutralising the IL 17A, this biologic reduces inflammation in your body.

The first anti IL 17A secukinumab (Cosentyx) was approved by NICE and the Scottish Medicines Consortium in 2016.

  • Self administered by an injection pen device
  • Treatment starts with 4 ‘loading’ doses. After your first dose (week 0) you inject your medication weekly at weeks 1, 2 and 3. On week 4 you will receive the first of your monthly injections. After that you will continue to inject monthly.

Read the NASS Guide to Biologic Therapy

Read the British Society for Rheumatology (BSR) Biologic safety guidelines

Rheumatologist, Dr Andrew Keat, explains biologic treatments and patients share their experiences

Read more