Biologics are drugs made of complex molecules that producers extract from biological sources, such as animal cells. Although there is evidence to suggest that biologics can improve symptoms of ankylosing spondylitis (AS), these drugs remain much more expensive than many alternatives.

AS is a chronic inflammatory condition that affects a person’s axial spine, causing pain and stiffness.

This condition primarily affects younger people. Around 80% of people with AS develop their symptoms before the age of 30.

Recently, doctors have been treating AS with drugs known as biologics.

This article will explore:

  • what biologics are
  • how biologics can treat AS
  • how doctors administer biologics
  • costs
  • side effects
  • types of biologics for AS

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Biologics are drugs that are made up of complex molecules. Unlike most other pharmaceuticals, manufacturers do not synthesize biologics from raw materials.

Instead, biologics manufacturers directly extract the complex molecules from biological sources, such as plant or animal tissues. The manufacturers may then further process those molecules, although that extra processing is not always necessary.

Biologics for AS are simply those biologic drugs that doctors use to treat AS.

As a 2021 review explains, inflammation due to AS can cause a wide variety of symptoms. Because the inflammation can spread to other body parts, AS can lead to symptoms outside of the axial spine. Symptoms and complications of AS include:

  • chronic back pain
  • spinal stiffness
  • postural characteristics that are atypical
  • buttock or hip pain
  • peripheral arthritis
  • inflammatory bowel disease
  • acute anterior uveitis
  • psoriasis

Like other kinds of medication, biologics can produce a variety of effects.

A 2017 paper explains that there are three main types of biologics:

  • monoclonal antibodies, which prompt a person’s immune system to respond to pathogens
  • receptor modulators, which bind to chemical receptors in the cells, causing them to change their behavior
  • enzyme replacements or modulators, which act as stand-ins for certain enzymes or alter existing enzymes

A common subtype of biologics for AS is anti-tumor necrosis factor (anti-TNF) drugs, which are a variety of monoclonal antibodies.

Scientists consider anti-TNF drugs to have revolutionized AS treatments.

Doctors have a variety of ways to administer anti-TNF drugs, including via subcutaneous injections, via infusions, and intravenously.

When it is possible for doctors to administer a drug in multiple different ways, the individual may be able to choose which one they would prefer.

One downside of using biologics to treat AS is the cost. Although effective, these medications are expensive.

For example, there is evidence that the average monthly costs for some common AS medications are as follows:

  • adalimumab: $1,214 per person per month
  • etanercept: $1,067 per person per month
  • infliximab: $1,435 per person per month

These costs applied to Brazil between 2010 and 2013. Depending on a multitude of different factors, people in the United States could be paying even more for such treatments.

A 2018 study notes that biologics for AS are so expensive that some people taper their medications as time goes by.

Tapering involves slowly reducing the amount of medication as time goes on. However, tapering biologics for AS remains controversial in the medical community. This is because some evidence suggests that tapering could make the treatment less effective.

Despite the potential for biologics to help treat AS, these medications come with some possible side effects.

For instance, a 2019 study lists some potential side effects of anti-NTF drugs as follows:

  • the development or worsening of psoriasis
  • demyelinating diseases
  • infections
  • congestive heart failure

Few drugs come without any potential side effects. An individual with AS will want to speak with a doctor about potential adverse effects when considering biologics for treating their condition.

Whether or not to take any particular biologic medication for AS will depend upon many different factors.

Because certain side effects may be more likely to affect certain people more than others, doctors may discourage someone from taking certain biologics, even if they would help with their AS.

It is also important to remember that not every biologic medication is able to help with AS. Although research is ongoing, a 2020 review notes that certain biologic medications have not shown any obvious or significant positive effects on people’s AS. These include:

  • anakinra
  • abatacept
  • rituximab
  • tocilizumab
  • apremilast
  • risankizumab

AS is a serious inflammatory condition that affects a person’s spine. Scientists have developed a wide array of biologics for treating AS.

These medications can be very helpful, although they do come with some potential side effects.

As research continues, biologics may continue to help some individuals manage their AS.