title: An update on the use of tumor necrosis factor alpha inhibitors in the treatment of ankylosing spondylitis.
abstract: Ankylosing spondylitis is a chronic immune-mediated disease affecting the sacroiliac joints and the spine manifesting with new bone formation and osteopenia. Over the past decade, tumour necrosis factor alpha (TNF-α) inhibitors (TNFi) have become the cornerstone for therapy in improving functional outcomes, and decreasing disease activity in patients with a marginal benefit from non-steroidal anti-inflammatory (NSAID) therapy. At this time, it remains to be determined whether these agents decrease new bone formation, although some studies have recently suggested that. Areas covered: In this review we discuss the factors that favour a good response to these agents both initially and during maintenance, and some of the more recent studies outlining strategies for dose reduction. Expert commentary: Finally, we discuss the importance of using more objective tools for disease activity, such as magnetic resonance imaging, as a complementary tool for clinical assessments in both predicting responses to treatment but also in selecting patients most suited for targeted therapy.
authors.affiliation: a Division of Rheumatology, Department of Medicine , University of Alberta , Edmonton , AB , USA.
authors.forename: Mohammed S
authors.initials: MS
authors.lastname: Osman
authors.affiliation: a Division of Rheumatology, Department of Medicine , University of Alberta , Edmonton , AB , USA.
authors.forename: Walter P
authors.initials: WP
authors.lastname: Maksymowych
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D054316:Biomarkers, Pharmacological; D002986:Clinical Trials as Topic; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D010012:Osteogenesis; D012446:Sacroiliac Joint / Q000473:pathology*; D013131:Spine / Q000473:pathology*; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology
chemical_list: D000911:Antibodies, Monoclonal; D054316:Biomarkers, Pharmacological; D014409:Tumor Necrosis Factor-alpha
keywords: Ankylosing spondylitis; TNF alpha inhibitors; adalimumab; axial spondyloarthritis; biological agents; certolizumab; etanercept; golimumab; infliximab; new bone formation