title: Treatment of ankylosing spondylitis in patients refractory to TNF-inhibition:  are there alternatives?
abstract: OBJECTIVE
  Axial spondyloarthritis (SpA) - including ankylosing spondylitis (AS) - is a frequent chronic inflammatory disease that affects mainly the axial skeleton. There is evidence that NSAIDs and tumor necrosis factor (TNF) α blockers are efficacious, but not all patients achieve remission or a major clinical response. A variety of new drug classes have been investigated during the last years for the treatment of patients with AS in whom TNF blockers have failed or are contraindicated.
  
  
  RESULTS
  Data for abatacept, anakinra, apremilast, bisphosphonates, rituximab, secukinumab, sulfasalazine, thalidomide and tocilizumab were found. All studies had problems with design and methodology.
  
  
  CONCLUSIONS
  Although some trends for efficacy were seen, there is at present insufficient evidence to support a recommendation for any of these compounds. So far, none of these new drugs has been shown to reach response rates compared to TNF-blockers.
authors.affiliation: Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus, Landgrafenstr. 15, 44652 Herne, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Kiltz
authors.forename: Frank
authors.initials: F
authors.lastname: Heldmann
authors.forename: Xenofon
authors.initials: X
authors.lastname: Baraliakos
authors.forename: Juergen
authors.initials: J
authors.lastname: Braun
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha