Spine Community News: SPARTAN is a research and treatment network organization that includes expert clinicians and researchers who care for patients with spondyloarthritis. At this 16th Annual meeting research was presented that increases our understanding of these disorders that affect the spine.
The first session of the meeting dealt with current treatment of axial spondyloarthritis (ankylosing spondylitis). Treatment of spondyloarthritis includes pharmacologic and nonpharmacologic components. Dr. Philip Mease discussed the effects of Il-23/1l-17 inhibitors in the treatment of spondyloarthritis. Of the two, inhibition of IL-17 seems to be a more effective treatment for AS. IL-17 cells are located in anatomic sites associated with inflammation resulting in the characteristic structural changes associated with the illness. These cells are present at attachments of tendons to bones (entheses), a specific location for inflammation in the spine and peripheral joints for patients with spondyloarthritis. Examples of anti IL-17 drugs are Cosentyx (secukinumab) and Taltz (ixekizumab). Clinical trials have demonstrated the efficacy of these agents in the treatment of ankylosing spondylitis and psoriatic arthritis. Clinical trials of anti-IL 23 biologics Stelara (usetikizumab) have not shown effectiveness in AS.
Dr. Jonathan Kay discussed the use of biosimilars in spondyloarthritis. Biosimilars are proteins that are similar, but not identical, to the originator biologic agents that are used in the treatment of ankylosing spondylitis. For example, 2 biosimilars are available for Remicade (infliximab), Inflectra and Renflexis. Despite equivalency in efficacy and safety, only a very small proportion of spondyloarthritis patients are receiving one of these biosimilar agents. The biggest selling point for the use of biosimilars is less expense. Although the cost of a biosimilar is less, pharmacy benefit managers versus patients are realizing the decreased cost. Patients are not spending less on these biosimilars. Therefore, the brand name product remains the preferred agent.
Angelo Papachristos, a physical therapist, described nonpharmacologic therapies effective for spondyloarthritis. In a sentence, the scientific evidence demonstrating the beneficial effects of exercise is indisputable and the benefits of exercise far outweigh the risks in most adults. Further discussion of his recommendations will be in my next post.
David Borenstein, MD
Executive Editor TheSpineCommunity.com