Anti-TNF drugs in ankylosing spondylitis: the present and future

摘要

Evaluation of: van der Heijde D, Schiff MH, Sieper J et al.: Adalimumab effectiveness for the treatment of ankylosing spondylitis is maintained for up to 2 years: longterm results from the ATLAS trial. Ann. Rheum. Dis. (2008) (Epub ahead of print). In contrast to the situation in rheumatoid disease where a variety of inexpensive disease-modifying agents exist (e.g., methotrexate), no such agent modifies disease in ankylosing spondylitis. Therefore, the arrival of anti-TNF drugs has been an enormous contribution. All the anti-TNF agents are efficacious in this condition, and this article reviews data regarding adalimumab in ankylosing spondylitis. In the future, we will need to define which anti-TNF agent should be considered the drug of choice for which type of disease. Important outstanding issues exist, such as should anti-TNF be given very early, following symptom onset, in order to turn off the disease process rather than merely suppress symptoms? The long-term will certainly see more anti-TNF agents, and the hope remains that as the choice increases, the price will reduce. In societal terms, this class of drug is cost-effective, given there are patients who can continue with work and return to the workplace after a few weeks or months of treatment.