Switching Biologics for Ankylosing Spondylitis

Along your treatment journey, you may switch the biologics you take for ankylosing spondylitis. There is much to consider before swapping your meds. Weighing the benefits and costs listed below can help you see if switching biologics is right for you.

Why do people switch biologics?

People with AxSpA who switch biologics often do so to achieve better results. The biologic they take may not work well. Biologics can also become less effective over time.^1-3

Having negative side effects may also affect your decision to switch. A study showed adverse effects were the main reason people switched from tumor necrosis factor inhibitors (TNFi) for ankylosing spondylitis (AS). In another study, people with inflammatory arthritis and ulcerative colitis switched biologics because of adverse effects or because the first biologics they tried stopped working as well.^2,3

Side effects with a new biologic can even cause a person to switch back to the biologic they took at first. A study reported this occurring in up to 1 in 4 people. Several studies found this switch-back occurred a lot with people who replaced Enbrel® (etanercept) with Benepali® (SB4).²

Sometimes people switch biologics because of changes in the drug itself or access to the drug. Drugmakers may put a generic biologic (called a biosimilar) on the market. They may also take a biologic off the market.¹

The cost of drugs may also have an impact on your decision to switch biologics. A study found that most people switch from TNFis to biosimilars, which can cost less. A person may also opt to try another drug if their health insurance no longer covers their current biologic.²

How many people switch biologics?

According to 1 study, 1 in 4 people taking TNFi for AS made a change in the first year. After 5 years, less than half of these people were still taking the TNFi they started with. Of those, 63 percent were taking another biologic, and 30 percent had stopped anti-rheumatic treatment.³

Another study looked at almost 800 people with AS who had just started a biologic. Out of those, 15 percent switched biologics in the first 12 months. Nearly 32 percent stopped taking biologics in that same timeframe.¹

Is switching biologics safe?

Most people can safely switch biologics. But there are some things to consider. ²

At first, switching biologics may lead to an increase in symptoms. The full benefit of these drugs tends to come over time, but the symptoms can show up right away. One study showed that people stuck with each new biologic for less time.²

Another study showed that people who switched biologics for AS needed more healthcare. They went to the doctor more often. They also made more trips to the emergency department.¹

The outcome from switching biologics varies from person to person. Some respond better when they shift from an older to a newer biologic. Choosing the right biologic is so important for symptom control, but it can be hard to find one that works just right. Starting the new biologic as soon as you can after stopping the last one can also have better results and less side effects.⁴

Is switching biologics costly?

Switching biologics can cost you more. There's a chance you could lose money if you switch before you finish a biologic for which you already paid. And you will incur the costs of paying for something new.²

That being said, a drug that works better for you may be worth the extra expense! It's entirely up to you and your healthcare team to decide what works best.

On the other hand, switching biologics may save money for certain people. This may happen if you take biosimilars in place of biologics. Biosimilars are similar to biologics but often come at lower prices.²

People with AxSpA can safely switch biologics and improve as a result. But certain people who swap biologics may get worse and need more healthcare. In either case, healthcare payers and the people who switch biologics both spend more money.¹ But no matter what, it's important to prioritize what works for you. Like we've said before, switching biologics is a personal decision between you and your healthcare team.

If you have AxSpA, starting with a biologic that you can continue long-term is best, though we know that can be difficult to find and things can change. Talk to your doctor about which biologic to take first. Your doctor can also help if you want to switch biologics for some reason. They can review your health history and suggest which other treatments might work well for you.