Biological or targeted-synthetic disease-modifying antirheumatic drugs for ankylosing spondylitis
Baeten, 2015Maxwell, 2015Poddubnyy, 2014
Tumour necrosis factor (TNF) inhibitors are the most commonly used bDMARDs for treating ankylosing spondylitis. However, b/tsDMARDs with other mechanisms of action, including interleukin (IL)-17 inhibitors (eg secukinumab, ixekizumab), and Janus kinase (JAK) inhibitors (eg upadacitinib), are also effective at treating ankylosing spondylitis and are becoming increasingly available.
The TNF inhibitors are generally considered to be equally effective in the management of ankylosing spondylitis, and drug choice is influenced by patient preference regarding route of administration and dosing frequency. TNF inhibitors other than etanercept may be preferred in some people because etanercept is often less effective for the management of inflammatory bowel disease and uveitis, which are common comorbid conditionsRoche, 2021.
The usual dosages of b/tsDMARDs that are listed on the PBS for ankylosing spondylitis (in alphabetical order) are:
adalimumab 40 mg subcutaneously, every 2 weeks adalimumab adalimumab adalimumab
OR
bimekizumab 160 mg subcutaneously, every 4 weeks bimekizumab bimekizumab bimekizumab
OR
certolizumab pegol 400 mg subcutaneously, as a single dose at 0, 2 and 4 weeks, then 200 mg subcutaneously, every 2 weeks thereafter certolizumab pegol certolizumab pegol certolizumab pegol
OR
certolizumab pegol 400 mg subcutaneously, as a single dose at 0, 2 and 4 weeks, and thereafter every 4 weeks certolizumab pegol certolizumab pegol certolizumab pegol
OR
etanercept 50 mg subcutaneously, once weekly1 etanercept etanercept etanercept
OR
golimumab 50 mg subcutaneously, every 4 weeks golimumab golimumab golimumab
OR
infliximab 5 mg/kg intravenously, as a single dose at 0, 2 and 6 weeks, and thereafter every 6 weeks infliximab infliximab infliximab
OR
ixekizumab 80mg subcutaneously, every 4 weeks ixekizumab ixekizumab ixekizumab
OR
secukinumab 150 mg subcutaneously, as a single dose at 0, 1, 2, 3 and 4 weeks, and thereafter every 4 weeks secukinumab secukinumab secukinumab
OR
upadacitinib 15mg orally, daily. upadacitinib upadacitinib upadacitinib