Biologics for Ankylosing Spondylitis
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How It Works
Another name for these medicines is Tumor Necrosis Factor-alpha antagonists (anti-TNF alpha agents). These medicines stop a protein that increases inflammation in the body. They block the inflammatory response that happens in ankylosing spondylitis. They are given as a shot.
Why It Is Used
Biologics are used to treat pain and inflammation in people who have active ankylosing spondylitis. They are usually used after other medicines such as nonsteroidal anti-inflammatory drugs (NSAIDs) have been tried.
How Well It Works
Biologics may improve symptoms of ankylosing spondylitis, such as morning stiffness and pain. These medicines might allow a person to be more active.1, 2 You may feel better in 6 to 12 weeks after starting this medicine. If one of these medicines does not work, you might find relief with another.
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Call 911 or other emergency services right away if you have:
- Trouble breathing.
- Swelling of your face, lips, tongue, or throat.
Call your doctor right away if you have:
- Signs of illness or infection, such as chills, cough, or fever.
- Chest pain or tightness.
- A rash on your head, face, or belly.
- Belly pain or fullness.
- Lower back or side pain, especially with painful urination.
Common side effects of this medicine include:
- Stomach pain, nausea, and vomiting.
- Painful throat.
- Redness, itching, or swelling at the injection site.
- Skin problems, such as bleeding, blistering, or crusting.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Because biologics interfere with the immune system, it's possible that they may raise your risk for infection, anemia, and possibly even cancer. Medicines that suppress the immune system are not usually given to people who have impaired immune systems. If you take biologic drugs, you may have periodic tests for tuberculosis.
Warnings have been issued about the serious side effects of biologics. The U.S. Food and Drug Administration (FDA) and the drug's manufacturers have warned about:
- An increased risk of a serious infection. Biologics affect the body's ability to fight all infections. So if you get a fever, cold, or the flu while you are taking this medicine, let your doctor know right away.
- An increased risk of blood or nervous system disorders. Call your doctor if you have symptoms of blood disorders (such as bruising or bleeding) or symptoms of nervous system problems (such as numbness, weakness, tingling, or vision problems).
- An increased risk of lymphoma (a type of blood cancer) in children and adolescents who take this medicine for longer than 2½ years (30 months). Adults, children, and adolescents who take this medicine also have a higher risk for leukemia and other cancers.
- An increased risk of liver injuries. Call your doctor if your skin starts to look yellow, if you are very tired, or if you have a fever or dark brown urine.
- An increased risk of psoriasis.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
- Van der Linden S, et al. (2009). Ankylosing spondylitis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 2, pp. 1169–1189. Philadelphia: Saunders Elsevier.
- Golimumab (Simponi) for inflammatory arthritis (2009). Medical Letter on Drugs and Therapeutics, 51(1316): 55–56.
Last Revised: May 14, 2013
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