by Dr. David Borenstein M.D. 1/2020

Executive Editor

A systematic review of available research has just reported on the long-term effects of nonsteroidal anti-inflammatory and biologic therapies on the structural progression in the spine of disorders like ankylosing spondylitis (AS). The report reviewed 18 studies involving tumor necrosis factor (TNF) inhibitors, like Humira (adalimumab), and Enbrel (etarnercept), 8 involving non-steroidal anti-inflammatory drugs (NSAIDs), like celecoxib, meloxicam, and 1 involving an interleukin 17 inhibitor (IL-17), like Cosentyx (secukinumab).

The studies looked at results at 2 years and 4 years although not all studies had data for the full 4 year duration. At two years duration, none of the studies of active therapies compared to controls were able to demonstrate inhibition of spinal radiographic progression. At 4 years with studies that were completed without bias, anti-TNF therapies showed a significant improvement in slowing progression compared to placebo. Since the evaluated studies of NSAIDs, and IL-17 inhibitors only had data at 2 years, no specific statement could be made concerning the benefits of these therapies if they were used for a similar duration of 4 years.

The results from this study suggest long-term treatment for patients with AS of 4 years or longer with anti-TNF therapy can have a significant impact on the progression of their illness. Additional studies of longer duration need to be completed for NSAIDs and anti-IL-17 agents in order to determine their benefit on structural alterations in the spine. Until that time, NSAIDs and IL-17 therapies can be recommended if patients with spondyloarthritis are clinically improved (less morning stiffness, normalization of inflammatory markers like C reactive protein).


  1. Karmacharya P et al. The Effect of Therapy on Radiographic Progression in Axial Spondyloarthritis: A Systematic Review and Meta-Analysis. Arthritis Rheum doi: 10.1002/ART.41206