Switching Medications for Ankylosing Spondylitis: Is It Worth Trying?

Switch back to the original medication?

Hello Doctor: My son is 19 years old and has ankylosing spondylitis.
He only experiences pain in the sacroiliac joints, and there is no pain in the peripheral joints, nor has he ever experienced morning stiffness.
He is currently taking Celecoxib, and he was able to control his symptoms and pain with an average of 1.5 capsules per day.
However, recently, even with an increase to 2 capsules per day for a month, he has been unable to control his symptoms and pain.
I previously consulted a doctor about this issue, and the doctor suggested trying adding Sulfasalazine.
I would like to ask the doctor if, in addition to adding Sulfasalazine, I can switch from Celecoxib to Meloxicam.
However, my son took Meloxicam a year before starting Celecoxib, and there was no improvement in his symptoms or pain at that time.
Do you think switching from Celecoxib to Meloxicam might be effective now? Thank you.

Jie, 10~19 year old female. Ask Date: 2022/02/18

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
If you are taking Salazopyrin, you need to increase to the therapeutic dose and continue using it for at least three months for the effects to become noticeable.
If the current treatment with Xeljanz is not effective, you might consider trying Rinvoq.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/02/18

More Info

When considering a switch in medications for Ankylosing Spondylitis (AS), it is essential to weigh the potential benefits and risks associated with the new treatment options. Your son, at 19 years old, is currently taking Celecoxib (known as "Celebrex" in the U.S.) and has experienced some relief but is now facing challenges in managing his symptoms effectively, even with an increased dosage.
Ankylosing Spondylitis is a chronic inflammatory disease primarily affecting the spine and the sacroiliac joints, leading to pain and stiffness. The treatment typically involves nonsteroidal anti-inflammatory drugs (NSAIDs) like Celecoxib, which help reduce inflammation and pain. However, if the current medication is no longer providing adequate relief, it may be time to consider alternatives.

Your doctor has suggested adding a second medication, which is a common approach when a single medication fails to control symptoms adequately. The addition of another drug can enhance the overall therapeutic effect. In this case, the suggestion of adding "Salar" (likely referring to a biologic agent such as Secukinumab or another DMARD) could be beneficial, as these medications target specific pathways in the inflammatory process of AS.

Switching from Celecoxib to another NSAID, such as "Voltaren" (Diclofenac), could also be an option. However, since your son previously tried Voltaren without improvement, it may not be the best choice. The effectiveness of NSAIDs can vary significantly among individuals, and what works for one person may not work for another.
It is also crucial to consider the potential side effects of any new medication. Both NSAIDs and biologics can have adverse effects, and monitoring for these is essential. For instance, NSAIDs can lead to gastrointestinal issues, cardiovascular risks, and kidney problems, while biologics may increase the risk of infections due to their immunosuppressive effects.

Before making any changes to your son's medication regimen, it is vital to have a thorough discussion with his healthcare provider. They can assess his current condition, review his medical history, and consider any other factors that may influence the effectiveness of the new treatment. Additionally, they may recommend other supportive therapies, such as physical therapy, exercise, or lifestyle modifications, which can significantly improve quality of life for AS patients.

In summary, switching medications for Ankylosing Spondylitis can be worthwhile, especially if the current treatment is no longer effective. However, it is essential to work closely with a healthcare provider to determine the best course of action, considering both the potential benefits and risks of any new treatment. Your son's health and well-being should always be the top priority, and a collaborative approach will ensure he receives the most appropriate care for his condition.

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