← Questions/TREATMENT
Are these drugs safe to stay on for years?
The short answer
The largest real-world study, over 56,000 people followed for five years, found no increase in cancer with sustained TNF, IL-17 or JAK treatment, and people with AS who do get common cancers survive them as well as anyone else. Three-year data on bimekizumab showed no deaths or major heart events, with mild fungal infections the main side effect; JAK inhibitors showed no excess clots or heart attacks in spondyloarthritis trials, though those trials were small. Biologics do not change fracture risk; steroid tablets do.
8 papers behind this answer, best first
Clicking through to a study? How to read a paper is the ten-minute version.
Risk of Cancer According to Duration of Targeted Therapy Exposure in Spondyloarthritis: A Nationwide Cohort Study From the French Health Insurance Database
Arthritis & Rheumatology
Following 56,591 people with spondyloarthritis in France for a median of five years, those taking a targeted therapy for more than six months a year had slightly lower overall cancer risk than those taking it less. Staying on a TNF, IL-17 or JAK drug did not raise cancer risk in this very large real-world group, which addresses a common worry about long-term treatment.
Survival Outcomes in Older Adults with Axial Spondyloarthritis and Concomitant Cancer
Arthritis Care & Research
In US Medicare data on over 6,000 older adults with axial spondyloarthritis who developed breast, prostate, lung or bowel cancer, five-year survival was the same as for people without axSpA, and slightly better for bowel cancer. Having axSpA does not appear to worsen your chances if you get one of these common cancers later in life.
Bimekizumab Long-Term Safety and Efficacy Across the Spectrum of Axial Spondyloarthritis Over 3 Years: Results From 2 Phase III Studies.
The Journal of rheumatology
Three years of bimekizumab (Bimzelx) in 574 people across the whole axial spondyloarthritis spectrum showed no deaths or major heart events, with mild thrush-type fungal infections the main side effect and rates falling by year three. Benefits held steady, so for people weighing a long-term IL-17 drug the safety picture so far is reassuring.
Cardiovascular and Thromboembolic Risk With Upadacitinib in Spondyloarthritis and Inflammatory Bowel Disease: A Meta-Analysis of Randomized Controlled Trials.
Journal of cardiovascular pharmacology
Pooling eight randomised trials of 4,433 people with spondyloarthritis or inflammatory bowel disease, upadacitinib (Rinvoq) showed no increase in heart attacks, strokes or blood clots compared with placebo, though events were rare enough that the result cannot rule out a small risk. The signal that led to warnings on JAK drugs came from older rheumatoid arthritis patients; in this population, the trials so far are reassuring but not conclusive.
Efficacy and safety of tofacitinib in ankylosing spondylitis patients: a systematic review and meta-analysis.
Clinics (Sao Paulo, Brazil)
Pooling the randomised trials of tofacitinib (Xeljanz) in ankylosing spondylitis, people on the drug were about twice as likely to reach the standard response targets, with gains in function and quality of life, and overall side-effect rates matched placebo apart from more upper respiratory infections. It confirms tofacitinib as an effective oral option, with colds and sinus infections the main trade-off.
Disease-modifying anti-rheumatic drugs and systemic glucocorticoid use and risk of vertebral fractures in axial spondyloarthropathies: a systematic review and meta-analysis.
Clinical rheumatology
Across ten studies, biologic and conventional disease-modifying drugs neither raised nor lowered the risk of spinal fractures in axial spondyloarthritis, and TNF and IL-17 drugs were no different from each other, but steroid tablets raised fracture risk by about 38 percent. Controlling inflammation does not by itself protect the spine from breaking, so bone health needs its own attention, and steroids are best kept to a minimum.
Paradoxical psoriasis in axial spondyloarthritis and rheumatoid arthritis treated with b/tsDMARDs: a retrospective cohort study.
Clinical rheumatology
Among 1,588 people on biologics for axial spondyloarthritis or rheumatoid arthritis, about 2 percent developed a psoriasis-like rash caused by the drug, almost always a TNF blocker, with smoking the only independent risk factor; stopping the drug cleared it in most, and switching to a non-TNF drug worked. If a new rash appears on a TNF blocker, it may be the drug, and there are good alternatives.
Male sexual dysfunction associated with TNF-α inhibitors: an indication-stratified global pharmacovigilance analysis.
Frontiers in pharmacology
Searching the WHO global side-effect database, researchers found no overall link between TNF blockers and male sexual dysfunction, but among reports from people with ankylosing spondylitis there was a modest excess for adalimumab and etanercept that did not hold up at the level of specific symptoms. The authors call it hypothesis-generating, which is fair: worth knowing about, not a reason to change treatment.
Plain-language guides on this from patient organisations
Reviewed sources written for patients. They cover the “what do I do” part that research papers can’t.
- NASS: Guide to advanced therapies, anti-TNF, IL-17 and JAK (PDF) ↗
National Axial Spondyloarthritis Society (UK)