The effect of tumor necrosis factor-blockade on new bone formation in ankylosing spondylitis: what is the evidence?
OBJECTIVE
Treatment of ankylosing spondylitis (AS) has seen remarkable advances since the introduction of therapies targeting tumor necrosis factor-alfa (TNFα). In addition to the excellent disease control achieved by these agents, recent evidence points to a possible disease-modifying potential of the drug. This novel finding can potentially change the landscape of AS treatment.


RESULTS
In this review, existing knowledge on mechanisms of new bone formation and ways to quantify and prevent progression are discussed. Evidence for disease-modifying potential of NSAIDs, short-term and long-term studies on TNFα inhibitors, and AS progression are discussed. A follow-up of more than 4 years is required to study disease modification in AS. Early and long-term therapy with tumor necrosis factor inhibitors appears to slow radiographic progression in AS.


CONCLUSIONS
New evidence for a disease-modifying potential of tumor necrosis factor inhibitors can change the AS treatment paradigm.
http://links.lww.com/COR/A16.
aDepartment of Medicine and Rheumatology, University of Toronto bUniversity Health Network, Toronto, Ontario, Canada.
Nigil
N
Haroon
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D018450:Disease Progression; D006801:Humans; D010012:Osteogenesis; D011859:Radiography; D013167:Spondylitis, Ankylosing / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha