iximab in the treatment of ankylosing spondylitis

Correspondence: Rebecca Grainger Malaghan Institute of Medical Research, PO Box 7060, Wellington, New Zealand Tel +64 4 499 6914 Fax +64 4 499 6915 Email [email protected] Abstract: Ankylosing spondylitis (AS) is a chronic, progressive disease characterized by infl ammation in the spine and sacroiliac joints which causes pain, stiffness and the potential for spinal ankylosis. It is associated with signifi cant functional impairment. It is common and since onset is often in young people, the burden of disease is considerable. Conventional treatment including non-steroidal antiinfl ammatory drugs (NSAIDs) and physiotherapy have proven but limited effi cacy in controlling symptoms and preventing progression of spinal manifestations. Infl iximab, a chimeric monoclonal antibody which binds to and inhibits tumor necrosis factor alpha (TNFα), is highly effective in controlling disease activity in AS. In AS, infl iximab 5 mg/kg body weight is usually given as an infusion at weeks 0, 2 and 6, and then every 6–8 weeks. When infl iximab is used in combination with NSAIDs a rapid improvement in disease activity by at least 50% is seen in as many as 50% of AS patients. Infl iximab has been shown to have ongoing effi cacy for as long as regular infusions continue and is safe in the medium term. Magnetic resonance studies show major reductions in spinal infl ammation during treatment with infl iximab, however ongoing studies will assess if infl iximab has disease modifying effect in AS.