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Which biological therapy for ankylosing spondylitis?

Q) I have been offered a choice of biological therapies for ankylosing spondylitis, which I have severely, but don’t feel I have sufficient knowledge to make the decision about which might work best for me. Can you offer any advice?
Mark, West Midlands (Summer 2014)

A) You will be aware that I can only offer the most general advice about this. Treatment choice is a matter for discussion between clinician and patient and should be an individualised decision. I would think that your rheumatology department has skilled nurses who can spend time with you and who can go over the various treatment options with you. The cost and potency of biological drugs mean that there are certain conditions to fulfil before you can be offered them, and these will have been taken into consideration by your rheumatologist. It is usually necessary for you to have not responded to two different disease-modifying anti-rheumatic drugs (DMARDs) and to have a certain level of disease activity, as judged by your doctor. If you have a history of tuberculosis, multiple sclerosis or cancer then these drugs are generally not advisable. Generally, all the biological drugs given for ankylosing spondylitis work by blocking TNF (tumour necrosis factor) and they all have similar efficacy, so choice depends a little on frequency of injection (most are self-injected) or, if a patient feels they can’t self-inject, there is an intravenous preparation.

This answer was provided by Dr Philip Helliwell for the Summer 2014 edition of our magazine, Arthritis Today, and was correct at the time of publication.

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