Ankylosing spondylitis (AS) is a chronic autoimmune that can result in inflammation and limited mobility. To help you manage symptoms of AS, a doctor may recommend a therapy called biologics.

AS primarily affects the spinal joints, but large joints, such as the hips and shoulders, can also be involved. It can cause joints to fuse in sections of the spine, which often leads to pain, swelling, and stiffness.

This can limit mobility, making it difficult to complete everyday tasks.

There’s no cure for AS, but different treatments can slow the progression and help you live an active life. A healthcare professional can put together and develop a treatment plan for you once you have been diagnosed.

Because symptoms of AS can range from mild to severe, some people may be able to manage their symptoms with nonsteroidal anti-inflammatory drugs (NSAIDs). If your symptoms don’t respond to those drugs, prescription medications, such as disease-modifying antirheumatic drugs (DMARDs), are the next line of defense.

Although they’re unable to target the exact cause of it, NSAIDs and DMARDs are both designed to stop inflammation.

Sometimes the pain and stiffness AS brings about doesn’t respond to these prescription medications. To help you manage symptoms, a doctor may recommend a different type of therapy called biologics.

Biologics are medications that consist of genetically engineered proteins. They’re created from living organisms that mimic healthy biological functions.

They’re a type of targeted therapy aimed at specific proteins in the immune system that produce inflammation, namely:

  • tumor necrosis factor (TNF)
  • interleukin 17 (IL-17)

Currently, seven types of biologics are approved for the treatment of AS. These include:

Tumor necrosis factor (TNF) blockers

  • adalimumab (Humira)
  • certolizumab pegol (Cimzia)
  • etanercept (Enbrel)
  • golimumab (Simponi, Simponi Aria)
  • infliximab (Remicade)

Interleukin 17 (IL–17) inhibitors

  • secukinumab (Cosentyx)
  • ixekizumab (Taltz)

Biologics must be delivered into tissue just under the skin. They’re not available in pill or oral form. You receive them through injections or infusions.

The frequency of injections or infusions needed will vary depending on the particular biologic therapy.

You may receive an infusion every few months, or you may require multiple starter injections and then follow-up injections throughout the year.

A doctor will tell you how often you’ll need biologic therapy, and they’ll give you instructions on how to administer your injections.

Biologics don’t improve symptoms of AS overnight, but you should begin to feel better in about 4 to 6 weeks, sometimes sooner.

The goal of treatment is to suppress your symptoms so that the condition doesn’t interfere with your life. It’s important to note that biologics won’t cure AS.

Biologics are often effective, but they’re very expensive in the United States. On average, the cost of biologics is $10,000 to $40,000 per year and sometimes far more for the most expensive agents.

Insurance will likely cover part of the costs, though it will depend on your coverage.

A doctor can help you understand your options, including alternative drugs such as biosimilars (similar formulations to biologics) and any patient assistance programs available through drug manufacturers.

There’s the risk of side effects or allergic reactions with many types of medications, and biologics are no exception.

Side effects of biologic therapy can include:

  • pain, discoloration, rash, or bruising at the injection site
  • headache
  • hives or rash
  • stomach pain
  • back pain
  • nausea
  • cough or sore throat
  • fever or chills
  • difficulty breathing
  • low blood pressure

These side effects are usually mild and will typically subside.

However, you should seek emergency medical support immediately if you have symptoms such as hives, swelling, or difficulty breathing. These could be signs of an allergic reaction.

Because biologics suppress your immune system, they can increase your risk for infections and certain cancers.

A doctor may order lab tests prior to your first injection or infusion to check for:

You should speak with a doctor if you develop signs of an infection after beginning treatment, such as:

  • fever
  • chills
  • shortness of breath
  • coughing

You should also notify a doctor if you have unexplained:

  • bruising
  • weight loss
  • unusual tiredness

Although all biologics for AS are intended to slow the progression of the disease and stop inflammation, biologics don’t work the same for everyone.

If you begin biologic treatment, a doctor may start you off with one type and monitor your condition over the next few months to see if there’s any improvement.

Don’t feel discouraged if your symptoms don’t lessen after your initial infusions or injections. If your AS doesn’t improve, a doctor may suggest switching to a different biologic approved for AS.

Biologic therapy alone isn’t the only option.

You shouldn’t take more than one biologic at a time due to the risk of infection, but you can take biologics with other medications for AS. Finding relief from AS is sometimes a matter of trial and error. It may take time to find the right combination of drugs.

For instance, though your symptoms didn’t improve while taking NSAIDs or DMARDs, combining a biologic with these medications may be effective.

The most common side effect of a biologic is often an infection, as the drug can interfere with your immune system.

The current new treatments for ankylosing spondylitis are interleukin 17 (IL-17) inhibitors, such as secukinumab (Cosentyx) and ixekizumab (Taltz).

Without proper treatment, AS can gradually progress and cause increased pain, stiffness, and limitation of movement.

Talk with a doctor if you feel that your current therapy isn’t working. You might be a candidate for biologics.

However, before starting biologic treatment (as with any treatment), make sure you know your options and ask questions.