TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis – guidance (TA383)

Adalimumab, certolizumab and etanercept are recommended as options for treating severe non-radiographic axial spondyloarthritis. These agents, as well as golimumab and infliximab are also recommended as options for severe active ankylosing spondylitis.

Infliximab is recommended only if treatment is started with the least expensive infliximab product.

Anti-TNF Treatment of both conditions is restricted to patients whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs.

 

The response treatment should be assessed after 12weeks and only be continued if there is clear evidence of response, defined as:

 

Reduction in the Bath Ankylosing Spondylitis Disease Activity Index score to 50% of the pre-treatment value or by 2 or more units and

 

A reduction in the spinal pain visual analogue scale by 2cm or more.

 

Consecutive use of a second anti-TNF agent is also recommended as an option for patients who fail to respond to, or fail to maintain a response to initial anti-TNF agent.