Just Keep Moving: Life With AS
Ankylosing Spondylitis

The Consumer’s Guide to Biologics for Ankylosing Spondylitis

Everything you need to know about biologics, the most targeted systemic medications available to treat ankylosing spondylitis.

I f you’re unhappy with your ankylosing spondylitis treatment, you may be wondering what’s next for you. That’s where biologics may come in. Biologics are a newer class of medications that have been proven to help with ankylosing spondylitis control.

The first biologic for ankylosing spondylitis was approved by the U.S. Food and Drug Administration (FDA) in 2003. Since then, more biologics have become available. These drugs have been proven to be effective at reducing inflammation that causes ankylosing spondylitis symptoms and leads to joint damage.

While biologics have been around for nearly two decades, you may have questions about how they work and whether they’re right for you. We’re here to help.


How Biologics Work for Ankylosing Spondylitis

Biologics, which are created using living cells similar to molecules in your immune system, work within the body to target the inflammation that contributes to ankylosing spondylitis symptoms at its source.
How Biologics Work for Ankylosing Spondylitis

Understanding Ankylosing Spondylitis: A Type of Inflammatory Arthritis

Ankylosing spondylitis is an inflammatory form of arthritis that primarily affects your spine. In ankylosing spondylitis, your immune system, which normally protects your body from foreign substances such as bacteria, viruses, and germs, becomes overactive, creating excess inflammation in the joints of your spine. This inflammation results in pain and stiffness and may cause new bone to form, which can eventually cause your spine to fuse in a fixed position.

The exact cause of this immune response is unknown, but a gene called HLA-B27 may play a role. HLA-B27 is part of a family of genes that helps the immune system tell the difference between foreign substances and your body’s own cells.

Many people with ankylosing spondylitis have the HLA-B27 gene, but not everyone with the gene develops the condition. An environmental trigger, such as an illness or bacterial infection, may activate the immune response of ankylosing spondylitis.

How Biologics Target Ankylosing Spondylitis Inflammation

Biologics are a type of disease-modifying antirheumatic drug (DMARD), meaning that in addition to relieving symptoms of ankylosing spondylitis, they also help block the inflammatory process in your body before it even starts. Unlike traditional DMARDs, which suppress the immune system on a broad level, biologics work by targeting specific molecules that play a role in triggering inflammation.

“Biologics target specific pathways known to cause inflammation in the cartilage, bones, and joints,” says Harris H. McIlwain, MD, a board-certified rheumatologist and founder of McIlwain Medical Group in Tampa, Florida. “When inflammation starts, there may be pain, stiffness, and fatigue. Biologics may halt the process of inflammation and end pain. In doing so, they may give excellent improvement in pain, inflammation, and function.”

7 Essential Facts About Biologics for Ankylosing Spondylitis

Here’s what you need to know before deciding if a biologic is right for you.
1. There are seven biologic medications approved for treating ankylosing spondylitis.

1. There are seven biologic medications approved for treating ankylosing spondylitis.

These biologics target different pathways thought to be associated with the inflammation of ankylosing spondylitis.

TNF-alpha inhibitors

TNF-alpha inhibitors

  • adalimumab (Humira®)
  • certolizumab pegol (Cimzia®)
  • etanercept (Enbrel®)
  • infliximab (Remicade®)
  • golimumab (Simponi®)
IL-17 inhibitors

IL-17 inhibitors

  • ixekizumab (Taltz®)
  • secukinumab (Cosentyx®)
2. Biologics are administered by infusion or injection.

2. Biologics are administered by infusion or injection.

Biologics for ankylosing spondylitis aren’t available in pill form. They must be given under the skin, either through an intravenous (IV) infusion in a medical office or clinic setting, or as an injection you can give yourself at home. How often you’ll need to administer treatment depends on the specific biologic you’re taking.

“The molecule size of a biologic is larger and usually requires injection rather than oral treatment,” says Dr. McIlwain. “Biologic medications are produced in living cells in a more complex process and require more complicated care.”

3. Most people will start to feel relief within 3 months.

3. Most people will start to feel relief within 3 months.

You may notice your symptoms begin to improve as soon as one week after starting a biologic, or it may take up to 12 weeks to notice a difference. Your symptoms may continue to improve for months afterward.

4. They may also help prevent related health conditions.

4. They may also help prevent related health conditions.

By reducing levels of inflammation in your body, biologics may help reduce your risk of developing health conditions related to ankylosing spondylitis, such as uveitis (eye inflammation), inflammatory bowel disease, and cardiovascular disease.

5. A biologic may become less effective over time.

5. A biologic may become less effective over time.

You may notice that a biologic becomes less effective after taking it for months or years. This may be because your immune system can develop antidrug antibodies that bind to the particular medication, reducing its therapeutic benefits. If this happens, your ankylosing spondylitis symptoms may start to come back. Your doctor may recommend trying another biologic; if one no longer works for you, switching to a different biologic might do the trick.

6. They’re considered safe but still come with risks.

6. They’re considered safe but still come with risks.

As with any medication, biologics come with potential risks and side effects. The most common are pain and redness at the injection site. Skin reactions are generally mild and go away on their own, but if you experience symptoms such as shortness of breath, dizziness, or fever, call your doctor, because these could be signs of an allergic reaction to the medication.

Because biologics work by suppressing your immune system, they also increase your risk of bacterial and fungal infections. What’s more, they may activate latent infections, including tuberculosis and hepatitis B and C, so you will need to be tested for these before starting a biologic. If you develop an infection while taking a biologic, it’s important to tell your doctor immediately so that it can be treated.

7. Insurance usually covers them.

7. Insurance usually covers them.

Biologics can cost $10,000 to $30,000 a year — and potentially up to $500,000 a year for the most expensive options. Most insurance companies will cover at least part of this cost, but how much and what you’ll need to pay out of pocket depends on your insurance plan.

If you’re concerned about paying for your medication, talk to your doctor, who can work with you to determine the best biologic for your insurance coverage and treatment needs. Your doctor can also discuss financial assistance options — state programs, pharmacy discount programs, and prescription assistance programs through the drug manufacturer’s website — that can help you get your medication for less or even no cost.

Is It Time to Try a Biologic to Treat Ankylosing Spondylitis?

If you’re struggling to control your ankylosing spondylitis symptoms, don’t lose hope. There are more treatments today than ever before, and your rheumatologist can help you find a treatment — or combination of treatments — that meets your particular needs.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first medication prescribed to treat ankylosing spondylitis. These drugs, which include over-the-counter and prescription options, help ease symptoms such as pain and stiffness.

If NSAIDs aren’t providing enough relief, you may be a candidate for a biologic.

Your doctor may prescribe a traditional DMARD, such as sulfasalazine, if you also have arthritis in the joints of your arms and legs. These are not typically used if ankylosing spondylitis affects your back only.

Your exact treatment plan will depend on a number of factors, including your disease severity, personal preferences, medical history, and overall health.

A Rheumatologist Answers Your Questions About Biologics

Harris McIllwain, MD, a board-certified rheumatologist and founder of McIllwain Medical Group in Tampa, Florida, answers the most common questions he hears from patients.

Next Steps: Making Ankylosing Spondylitis Treatment Decisions



You’ve learned a lot about biologics. So what’s next for you?

Take some time to think about your own ankylosing spondylitis care and whether biologics are something you might want to consider. Then talk to your doctor about your options.

Steps for Self-Reflection


Before your next appointment, reflect on these questions your doctor might ask you about your treatment plan.

  • Are you satisfied with your current ankylosing spondylitis treatment?
  • Has it improved your pain and other ankylosing spondylitis symptoms as well as you had hoped?
  • How often do you have to cancel plans or adjust activities because of ankylosing spondylitis?
  • Are you downplaying your symptoms — or their impact on your quality of life — to your doctor?
  • Are you following your treatment regimen as prescribed?
  • Have you tried other treatment options yet?

Conversation Starters for Talking to Your Doctor


If you decide it’s time to discuss a potential treatment change with your doctor, jot down some questions you’d like to ask. Here are a few conversation starters that you can save to your phone and bring to your next doctor’s appointment.

  • What can I do to improve my pain and stiffness?
  • Am I a good candidate for biologics?
  • Which medication are you prescribing for me and why?
  • What type of results do you expect?
  • How long should I use this medication before monitoring the progress?