TNF antagonists for ankylosing spondylitis

doi:10.1136/dtb.2005.43319

Drug and Therapeutics Bulletin 2005;43:19-22; doi:10.1136/dtb.2005.43319

TNF antagonists for ankylosing spondylitis

Relevant BNF section: 10.1.3

Up to 2 in 1,000 adults in the UK have ankylosing spondylitis.^1–3This chronic inflammatory disease causes pain and stiffnessin the spine and sacroiliac and peripheral joints, and may alsoaffect the eyes, heart and lungs.⁴ Characteristic features includeankylosis of the spine with a progressive loss of spinal mobility.Treatment with NSAIDs and physical therapy can provide symptomaticrelief of pain and stiffness, but does not modify the courseof the disease (e.g. slow or prevent ankylosis).^2,5 In general,disease-modifying antirheumatic drugs (DMARDs), such as gold,methotrexate and sulfasalazine,* have little or no effect inankylosing spondylitis.⁶ ${blacktriangledown}$ Etanercept (Enbrel - Wyeth) and ${blacktriangledown}$ infliximab(Remicade - Schering-Plough), two drugs which block the inflammatoryeffect of tumour necrosis factor (TNF), are now licensed forthe treatment of patients with severe ankylosing spondylitiswhose symptoms have not responded adequately to conventionaltherapy.^7,8 Here we review the place of these TNF antagonistsin the management of such individuals. _{* This new spelling reflectsthe use of recommended International Non-proprietary Names (rINNs)instead of former British Approved Names (BANs), as requiredby European law. For more information, see the British NationalFormulary, or http://medicines.mhra.gov.uk/inforesources/productinfo/banslist.pdf}