Is Daily Use of Celecoxib Effective for Managing Ankylosing Spondylitis?

Is this considered an effective treatment?

My son is currently 18 years old and started showing symptoms of ankylosing spondylitis two years ago, with a diagnosis made one year ago.
I have the following questions:
1) For the past six months, my son has been taking two capsules of Celebrex (200 mg each) daily, which has kept his CRP around 0.3 mg/dL and ESR around 12, and he has not experienced any pain (previously he only had pain in the sacroiliac joints).
His X-rays have not worsened.
However, if he reduces the dosage to one capsule daily, his levels rise after a month (CRP around 0.7, ESR around 20), and the pain returns.
Six months ago, he tried taking Enbrel, but it did not effectively control his inflammatory markers or pain.
Is his current regimen with Celebrex considered effective treatment? Should he continue taking Celebrex? (Note: Before starting medication, his CRP was around 1.7 and ESR was 38.)
2) Given my son's condition, is it difficult to apply for biologic agents under health insurance?
3) Should we consider self-paying for biologic agents if financially feasible? I am concerned about the long-term vascular and renal side effects of taking the maximum dosage of Celebrex daily.
However, I am also worried about the potential risks of tumors and infections associated with biologic agents.
4) If we disregard other factors and focus solely on age, which biologic agents—Enbrel, Remicade, or Simponi—are less suitable for an 18-year-old child?
5) Are there differences in the effectiveness of medications that control sacroiliac joint inflammation? For instance, could Celebrex be more effective for controlling inflammation in the left sacroiliac joint while requiring different medications (like Enbrel) for the right sacroiliac joint?

Zhong, 40~49 year old female. Ask Date: 2022/01/17

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
Here is my response summarized as follows:
1) My son has been taking 2 capsules of Celecoxib (200 mg) daily for the past six months, which has kept his CRP around 0.3 mg/dL and ESR around 12, and he has not experienced any pain (previously he only had sacroiliac joint pain).
His X-rays have not worsened.
However, if he reduces the dosage to 1 capsule daily, his levels will rise after a month (CRP around 0.7, ESR around 20), and the pain will return.
Six months ago, he had taken Methotrexate, but it did not effectively control his inflammatory markers or pain.
Is taking Celecoxib considered an effective treatment? Should he continue taking it? (Note: Before starting medication, his CRP was around 1.7 and ESR around 38.) --> If the inflammatory markers are likely to rise and he does not want to take anti-inflammatory medications like Celecoxib long-term, I recommend using Sulfasalazine.
This medication is not harmful to the kidneys and has a high safety profile.
Its side effects can be discussed with your child's physician.
Long-term use of Sulfasalazine can also help alleviate pain and reduce the need for anti-inflammatory pain medications.
Additionally, I would advise encouraging your child to exercise more, which can further reduce the use of anti-inflammatory pain medications.
2) Regarding my son's condition, is it difficult to apply for health insurance coverage for biological agents? --> Yes, it is not easy.
3) Should we consider self-paying for biological agents? (If financially feasible) I am concerned that taking the maximum dose of Celecoxib daily may have significant long-term side effects on blood vessels and kidneys.
However, I am also worried about the potential tumor and infection risks associated with biological agents.
--> I do not recommend it.
While biological agents can improve the disease course, they are not "curative" medications and have more side effects that require caution.
I usually reserve them for patients with more severe conditions.
Currently, your child's condition is manageable, so it may not be necessary.
4) If we only consider age, which biological agents—Enbrel, Humira, or Simponi—are less suitable for an 18-year-old child? --> They are all quite similar.
Humira may have a tendency to lose effectiveness over time, just for your reference.
5) Can medications that control sacroiliac joint inflammation differ in effectiveness? For example, could Celecoxib be suitable for controlling inflammation in the left sacroiliac joint but require other medications (like Methotrexate) for the right sacroiliac joint? --> No, that would not be the case.

Department of Allergy, Immunology, and Rheumatology, Changhua Hospital, Ministry of Health and Welfare, cares about you.

Reply Date: 2022/01/17

More Info

Managing ankylosing spondylitis (AS) effectively often requires a tailored approach, and the use of Celecoxib (Celebrex) has shown promise in controlling symptoms for many patients. Let's break down your questions regarding your son's treatment and the broader implications of using Celecoxib for AS.

1. Effectiveness of Celecoxib: Your son's experience with Celecoxib is quite telling. The fact that his CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) levels are well-controlled while on a daily dose of 400 mg (200 mg twice daily) suggests that Celecoxib is effectively managing his inflammation. The increase in inflammatory markers and pain upon reducing the dosage indicates that his body may rely on this medication to maintain control over his symptoms. Given that he has not experienced significant pain and his X-rays have not worsened, it is reasonable to conclude that continuing Celecoxib at the current dosage is beneficial. However, it is essential to regularly consult with his healthcare provider to monitor for any potential side effects, especially with long-term use.

2. Application for Biologic Treatments: Obtaining approval for biologic treatments can indeed be challenging, particularly in younger patients. Insurance companies often have strict criteria for coverage, which may include evidence of inadequate response to conventional therapies like NSAIDs (non-steroidal anti-inflammatory drugs) and DMARDs (disease-modifying antirheumatic drugs). Given your son's current management with Celecoxib, it may be necessary to document any flares or inadequate control of symptoms to support a case for biologic therapy.

3. Self-Paying for Biologics: If financially feasible, self-paying for biologic treatments could be an option. Biologics can provide significant relief for patients who do not respond adequately to traditional therapies. However, as you mentioned, there are risks associated with biologics, including increased susceptibility to infections and potential malignancies. It is crucial to weigh these risks against the benefits, especially considering your son's age and overall health.

4. Age Considerations for Biologics: When considering biologics like Enbrel (etanercept), Remicade (infliximab), and Humira (adalimumab), age is a factor, but it is not the only one. All these medications have been used in pediatric populations, but the choice may depend on individual health profiles, potential side effects, and the specific characteristics of the disease. Generally, the prescribing physician will consider the patient's overall health, disease severity, and response to previous treatments when recommending a biologic.

5. Variability in Treatment Response: It is possible for different patients to respond variably to medications like Celecoxib and other NSAIDs. Some patients may find that certain medications work better for specific areas of inflammation, such as the sacroiliac joints. This variability can be due to individual differences in disease presentation, genetics, and how the body metabolizes medications. If your son finds that Celecoxib is effective for one side but not the other, it may be worth discussing with his healthcare provider the possibility of adding or switching to another medication that could provide better control for the affected area.

In conclusion, it appears that Celecoxib is currently an effective treatment for your son's ankylosing spondylitis, and continuing its use under medical supervision seems prudent. Regular follow-ups with his healthcare provider will be essential to monitor his condition and adjust treatment as necessary. If considering biologic therapy, thorough discussions about the risks and benefits, as well as insurance coverage, will be crucial in making an informed decision.

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