Ankylosing Spondylitis Refractory to Tumor Necrosis Factor Blockade Responds to Tocilizumab

To the Editor: Tumor necrosis factor-α (TNF-α) antagonists are highly effective in treatment of ankylosing spondylitis (AS). However, some patients have an inadequate response and switching the anti-TNF-α inhibitors may be effective after an initial failure1. No other biologicals are approved for patients failing anti-TNF therapy. We describe a case of severe AS that was successfully treated with tocilizumab, the interleukin 6 (IL-6) receptor antagonist, after failing all 3 available anti-TNF-α inhibitors. A 45-year-old man had had B27-positive AS without peripheral arthritis since 1996. After insufficient responses to nonsteroidal antiinflammatory … Address correspondence to Dr. Cohen; E-mail: jd-cohen{at}chu-montpellier.fr