Infliximab in the treatment of active and severe ankylosing spondylitis

For treatment of the spondylarthropathies (SpA), of which ankylosing spondylitis (AS) is the prototype, there is no effective disease modifying treatment available. In contrast to rheumatoid arthritis (RA), few studies have been performed on the treatment of patients with AS with disease modifying antirheumatic drugs, none of which have proved clearly effective in axial disease. Many patients with AS carry a heavy burden of disease and AS itself is responsible for direct and indirect socioeconomic costs. To find an effective treatment for severe ankylosing spondylitis is therefore thought to be an unmet medical need. In the last four years several pilot studies and recently a few randomised controlled trials have raised good evidence that TNFalpha blockade is very effective in AS and other SpA. Disease activity, function and quality of life improved upon treatment with TNFalpha blockers. Thus, biologicals seem to represent a major breakthrough in the treatment of AS and other SpA. Side effects similar to those observed in RA treatment occur. But there is furthermore a need for safety data for long-term treatment with biologicals over several years. In the light of the high costs and the unknown long-term side effects, a definition for patients who might be candidates for such a treatment is needed. This article gives detailed information about current experience with the new treatment options in active and severe AS with anti-TNFalpha therapy.