NICE recommends TNF-alpha inhibitors for ankylosing spondylitis

NICE recommends Humira (adalimumab), from Abbvie, Cimzia (certolizumab pegol), from UCB, Enbrel (etanercept), from Pfizer, Simponi (golimumab), from Merck Inc and Remicade (infliximab), from Merck Inc, within their marketing authorisations, as options for treating severe active ankylosing spondylitis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs.

Infliximab is recommended only if treatment is started with the least expensive infliximab product. People currently receiving infliximab should be able to continue treatment with the same infliximab product until they and their NHS clinician consider it appropriate to stop. Nice also recommends Adalimumab, certolizumab pegol and etanercept, within their marketing authorisations, as options for treating severe non radiographic axial spondyloarthritis in adults whose disease has responded inadequately to, or who cannot tolerate, non-steroidal anti-inflammatory drugs. The response to adalimumab, certolizumab pegol, etanercept, golimumab or infliximab treatment should be assessed 12 weeks after the start of treatment. Treatment should only be continued if there is clear evidence of response, defined as a reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score to 50% of the pretreatment value or by 2 or more units and a reduction in the spinal pain visual analogue scale (VAS) by 2 cm or more.

Treatment with another tumour necrosis factor (TNF) -alpha inhibitor is recommended for people who cannot tolerate, or whose disease has not responded to, treatment with the first TNF-alpha inhibitor, or whose disease has stopped responding after an initial response.