Baseline predictors of response to TNF-α blocking therapy in ankylosing spondylitis

Curr Opin Rheumatol. 2012 May;24(3):290-8. doi: 10.1097/BOR.0b013e32835257c5.


Purpose of review: Identifying the characteristics of patients with ankylosing spondylitis (AS) before start of treatment which are able to predict a beneficial response to tumor necrosis factor-alpha (TNF-α) blocking therapy is relevant, especially in view of the high costs and potential side-effects of these agents. This review provides an overview of clinical trials and observational studies investigating baseline predictors of response after 3-6 months of TNF-α blocking therapy and baseline predictors of long-term anti-TNF-α treatment continuation in AS.

Recent findings: In multiple studies, increased acute phase reactants, higher disease activity, higher functional status, younger age, and HLA-B27 positivity were identified as independent baseline predictors of achieving clinical response to TNF-α blocking therapy. Increased acute phase reactants, presence of peripheral arthritis, and male sex were repeatedly identified as independent baseline predictors of anti-TNF-α treatment continuation.

Summary: Several studies using multivariate analyses identified comparable baseline predictors of response and/or continuation of TNF-α blocking therapy. The single predictors identified have, at best, moderate capacity to predict treatment response in the individual patient. The development of a prediction model may lead to a more robust instrument to support physicians in decision making on TNF-α blocking therapy in AS in daily clinical practice.

Publication types

  • Review

MeSH terms

  • Antirheumatic Agents / pharmacology
  • Antirheumatic Agents / therapeutic use*
  • Biomarkers / blood
  • Female
  • Humans
  • Male
  • Prognosis
  • Severity of Illness Index
  • Sex Factors
  • Spondylitis, Ankylosing / diagnosis
  • Spondylitis, Ankylosing / drug therapy*
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*


  • Antirheumatic Agents
  • Biomarkers
  • Tumor Necrosis Factor-alpha