Are Biologics Effective In Treating Ankylosing Spondylitis?

Ankylosing spondylitis (commonly referred to only as AS) is a chronic condition that causes joint inflammation in the spine and surrounding joints. In certain cases, the inflamed spinal joints may fuse together over a period of time, which causes stiffness in the spine, lower back, neck and hips. This triggers pain throughout the body but particularly centered on the affected joints. Treatment for ankylosing spondylitis revolves around medication and physical therapy. While over-the-counter pain medications are known to help with milder cases of ankylosing spondylitis, some patients require a different type of medication that helps suppress the immune system and also reduces inflammation in the body. These are known as biologics and they are emerging as the latest in the line of treatments available for ankylosing spondylitis. But are biologics really effective in treating ankylosing spondylitis? Let’s find out.

Are Biologics Effective In Treating Ankylosing Spondylitis?

Are Biologics Effective In Treating Ankylosing Spondylitis?

Biologics is a type of drug therapy that works by specifically targeting certain proteins that are responsible for causing inflammation in the body. As of now, there are six types of biologics that have been identified and approved for treating ankylosing spondylitis. These include:

  • Humira (adalimumab).
  • Cimzia (certolizumab pegol).
  • Enbrel (etanercept).
  • Simponi; Simponi ARIA (golimumab).
  • Remicade (infliximab).
  • Cosentyx (secukinumab).

It is natural to want to know whether or not biologics are actually an effective treatment for ankylosing spondylitis. As is the case with any treatment, the results of using biologics are also not guaranteed, but they are known to provide better results as compared to many of the over-the-counter and prescribed pain relievers that are available in the market today.

How To Understand If Biologics Are A Suitable Choice for Treating Your Ankylosing Spondylitis?

A better way to understand whether biologics are effective in treating ankylosing spondylitis is to ask yourself certain questions to better understand how your body responds to biologics. These include:

Q1. Biologics or Other Medications: Which Provided You More Relief?

To begin with, doctors do not prescribe biologics to everyone who suffers from ankylosing spondylitis. Only people suffering from moderate to severe levels of ankylosing spondylitis are prescribed biologics, that too when no other type of treatment seems to be working for ankylosing spondylitis patients. For general cases of ankylosing spondylitis, biologics are not typically the first line of treatment, with doctors opting to recommend some OTC medications to begin with in order to assess how well the medications help you manage your ankylosing spondylitis symptoms. Otherwise, your doctor may also prescribe an immunosuppressant drug or even a steroid injection (in rare cases) in the sacroiliac joints located in your pelvis. Both these treatments work by suppressing the immune system and providing relief from chronic inflammation which helps you manage your ankylosing spondylitis pain and symptoms.

If these treatments, combined with some lifestyle changes such as losing weight, regular exercising, controlling stress levels, etc., prove to be effective in managing your ankylosing spondylitis symptoms, then you may not need biologic therapy at all. However, if you notice that these standard treatments for ankylosing spondylitis have no effect on your symptoms, then biologics could be an effective choice of treatment for your ankylosing spondylitis.

Q2. Will You Be Able To Sustain And Keep Up The Scheduled Biologic Treatments For Your Ankylosing Spondylitis?

Biologics are not available in the form of a pill that you can just swallow and be done with. If you decide to undertake biologic therapy for the treatment of you ankylosing spondylitis, then you will receive infusions of the medications at the doctor’s office. This is done a couple of times during a year and depends on the type of biologic that is selected for your particular case. You will also have to give yourself injections in every one or two weeks. In order for biologic therapy to be effective in treating ankylosing spondylitis, you will have to follow this strict schedule of injections and infusions. If you stop the course of treatment, then your symptoms of ankylosing spondylitis will resurface. However, even if you are opting for being treated with biologics, you must keep in mind that biologics are not a cure for ankylosing spondylitis, and ultimately there is no cure for this disease and you will only have to manage your ankylosing spondylitis symptoms to get relief.

Q3. Will You Be Taking Any Other Medications Along With The Biologic Drug For Treating Ankylosing Spondylitis?

You have to keep in mind that many people do not respond to biologic treatment alone and may require to undertake a combination of drug therapies for treating ankylosing spondylitis. If you are selected as a candidate for biologic targeted therapy, then your doctor will most likely prescribe you only with one biologic drug, or you may also be prescribed a disease-modifying anti-rheumatic drug (DMARD) that will be taken along with your biologic drug for treating ankylosing spondylitis. It is not possible to take two biologics at the same time as it is considered to be unsafe. However, it is perfectly safe to combine one biologic drug with a DMARD drug. If you feel comfortable with this situation, then you may choose to opt for a biologic drug therapy for treating ankylosing spondylitis.

Things You Need To Know Before Starting A Biologic Drug For Treating Ankylosing Spondylitis

People respond differently to biologics and this is why there is no way of knowing whether or not the biologic treatment will work in providing relief in your condition of ankylosing spondylitis till the time you are well along on your course of treatment. Biologic therapy does not provide a quick-fix for inflammation of ankylosing spondylitis overnight. While some patients notice an improvement almost immediately after starting the biologic treatment, for others it may take anywhere between five to six weeks to several months to actually notice any significant difference in their symptoms of ankylosing spondylitis. This does not mean that if one biologic drug does not benefit you, others won’t either. There is a good enough possibility that you will be a suitable candidate for another biologic drug which can be effective for treating ankylosing spondylitis. Your doctor will be the best person to guide you in this regard.

Can Biologic Drugs Cure Ankylosing Spondylitis?

Biologics are also not a cure for ankylosing spondylitis. In fact, you may find that a biologic drug starts working wonders for your ankylosing spondylitis for some time and then it stops working over a period of time. In this case also your doctor may change you over to another biologic or may also opt for including a DMARD drug in your therapy to boost results in the treatment of ankylosing spondylitis. It is all a matter of finding just the correct combination of medications that will help keep your ankylosing spondylitis symptoms under control in the long term and also help slow down the progression of ankylosing spondylitis.

Who Should Not be Taking Biologics for the Treatment of Ankylosing Spondylitis?

Biologics are not meant for everyone who has ankylosing spondylitis. This is because biologics tend to suppress the immune system and thus, compromise it, making you more prone to catching infections and diseases. While these biologic drugs do not suppress the entire immune system like traditional immunosuppressant drugs, they nevertheless do have an impact on the immune system, which makes it difficult for many to fight off infections while being on biologic drugs for treatment. Therefore, if you have a weakened immune system, for example, if you have been diagnosed with hepatitis C or with HIV or if you are undergoing treatment for cancer or any other potentially life-threatening diseases, then your doctor will advise you against the use of biologics for managing the symptoms of ankylosing spondylitis. In such cases, the immune-suppressing qualities of biologic drugs could potentially worsen an existing infection and also make it more likely for you to catch another serious infection. If you have an active infection, you can always wait for the infection to clear up before asking your doctor again for the use of biologic therapy for ankylosing spondylitis.

Biologics are also not recommended for use in the long run. If you continue to use biologics for a long time, it significantly increases your risk of getting certain cancers such as lymphoma. If you are already taking a biologic drug and you catch a cold or develop the flu, which does not seem to get better even with medications and time, and it is also accompanied by symptoms such as weight loss, fatigue, or bruising, then you should immediately consult your doctor.


If you suffer from chronic stiffness and joint pain, it is not a good idea to continue to ignore these symptoms. If you notice these symptoms, then you should consult your doctor at the earliest. Ankylosing spondylitis is a debilitating disease that can cause a lot of ongoing pain, limit your mobility and greatly affect your quality of life. However, there are many treatments out there that can help you effectively manage your symptoms. If you do not seek any treatment for ankylosing spondylitis, then this disease will only continue to worsen and progress further. While the outlook for ankylosing spondylitis is positive with biologic treatment, it is crucial though that you find the correct biologic drug and follow the schedule for your infusions and injections correctly for effective treatment of ankylosing spondylitis.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:April 19, 2022

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