Adalimumab or etanercept are recommended as possible treatments for people with severe ankylosing spondylitis who:

  • have active spinal disease as assessed on two separate occasions 12 weeks apart, and
  • have tried at least two non-steroidal anti-inflammatory drugs (NSAIDs) but they have not worked.

Healthcare professionals should take into account any disabilities or difficulties in communicating that might mean that the standard assessments do not provide accurate information about a person's spinal disease.

Treatment should be started and supervised by a specialist who is experienced in diagnosing and treating ankylosing spondylitis. People taking adalimumab or etanercept should have regular check-ups. Treatment should continue only if the person's ankylosing spondylitis shows an adequate improvement. If the improvement is not maintained or if the drug stops working then treatment should be stopped.

If a person has to stop taking adalimumab or etanercept during the first 12 weeks of treatment because it has unwanted side effects, their specialist may offer them the other drug as an alternative. However, if treatment with adalimumab or etanercept does not work or stops working, the other drug should not be offered.

Infliximab is not recommended for people with ankylosing spondylitis. Healthcare professionals should not stop prescribing infliximab for people who were already taking it when the guidance was issued. These patients should be able to carry on taking infliximab until they and their healthcare professional decide that it is the right time to stop treatment.