Anti-TNF-alpha therapy in ankylosing spondylitis.
Ankylosing spondylitis (AS) is a frequent disease leading to functional impairment and socioeconomic burden. Anti-TNF-alpha therapy has brought new perspectives in this condition. Two agents are currently used in the treatment of AS and spondyloarthropathies - infliximab (a chimeric monoclonal antibody) and etanercept (a soluble p75 TNF-receptor). Open-label studies have shown the feasibility and efficacy of these drugs. Controlled studies have confirmed the latter, at least in the short-term (1 year). Improvement in several clinical parameters, function, quality of life, biological parameters and magnetic resonance imaging acute inflammation, have been observed. Due to these favourable results, anti-TNF have been approved for the treatment of AS. However, there are some safety concerns, essentially involving infection. Consensus guidelines for the use of anti-TNF in AS are available and assessment is based on validated tools. However, some questions still remain unanswered, such as the long-term efficacy and safety of anti-TNF, the possibility of structural benefit and the cost-effectiveness. Despite these concerns, Anti-TNF represents a major therapeutic advancement in the treatment of AS.
Wendling
Daniel
D
University Teaching Hospital Minjoz, Department of Rheumatology, Boulevard Fleming, F-25030 Besançon, France. daniel.wendling@ufc-chu.univ-fcomte.fr
Toussirot
Eric
E
D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000494:pharmacology / Q000627:therapeutic use*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept