What are the current NICE guidelines for the pharmacological management of ankylosing spondylitis?

Initial pharmacological treatment for axial spondyloarthritis, including ankylosing spondylitis, involves offering an NSAID at the lowest effective dose, with ongoing monitoring and gastroprotective treatment as needed ¹.

If an NSAID taken at the maximum tolerated dose for 2 to 4 weeks does not provide adequate pain relief, consider switching to another NSAID

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For patients with active ankylosing spondylitis with a BASDAI score of 4 or more and a spinal VAS of 4 cm or more, if NSAIDs are not tolerated or do not control the condition, NICE recommends considering biologic DMARDs such as tumor necrosis factor (TNF) inhibitors, including etanercept, infliximab, adalimumab, certolizumab pegol, and golimumab, based on NICE technology appraisals ¹.

Further pharmacological options for active disease include targeted synthetic DMARDs like tofacitinib, upadacitinib, and ixekizumab if TNF inhibitors are unsuitable or ineffective ¹.

Review treatment response after 3–6 months of anti-TNF therapy, and consider tapering if the patient is in sustained remission ¹.