Biologicals in Ankylosing Spondylitis: Current Concepts
Dr. Rashmi Sharma, MD. EX. Senior Demonstrator. PG Department of Pharmacology and therapeutics, Government Medical College, Jammu, J&K, India. Presently - Clinical Pharmacologist. Govt Hospital Vijay Pur, J&K Health Services, Jammu, India.
Ankylosing spondylitis (AS) is a systemic inflammatory rheumatic disease involving spinal and sacroiliac joints. Anti-TNF (tumour necrosis factor)-α agents have been found very effective for the treatment of both peripheral and axial symptoms in patients with AS. Etanercept, infliximab and adalimumab are approved by Food and Drug Administration (FDA) for AS. Systemic Lupus Erythematosus syndrome, demylinating diseases, neurodegenerative diseases, pancytopenia, severe infections, cardiovascular diseases etc. are some of the important side-effects reported with TNF-α blockers. TNF-α plays an important role in the host defense against mycobacterial infection, particularly in granuloma formation and inhibition of mycobacterial dissemination. There are recent reports of reactivation of tuberculosis after anti-TNF therapy. FDA recommended a black box for tuberculosis on the product labeling of infliximab. It is highly recommended to consider prophylactic anti- tubercular therapy (with isoniazid or isoniazid and rifampicin combination) before starting anti- TNFα therapy in patients with evidence of past history of tuberculosis or abnormal chest x-ray suggesting tuberculosis. However, extensive post-marketing surveillance is necessary to re-evaluate the risk-benefit ratio of these biologic therapies.