Condition

Ankylosing Spondylitis

Inflammatory arthritis affecting the spine

40M
People Affected
25
Active Trials
400K
New Cases/Year
2,000
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Upadacitinib
70% Effectiveness• 90% Confidence• 55% Safety• 5 trials• 5K participants
HIGH EvidencePoor ValueDose: 15mg or 30mg orally once daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
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55
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

Lifetime

Response Rate

75%

Remission Rate

38%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

100

Common Side Effects:

Upper respiratory tract infections: 20%
Nasopharyngitis: 15%
Nausea: 10%
Increased CPK: 5%
Acne: 5%
Serious infections: 3%
Major adverse cardiovascular events (MACE): 1%
Venous thromboembolism (VTE): 1%
Malignancies: 0.5%
Gastrointestinal perforation: 0.1%

Annual Cost of Care

Drug Cost

$50,000

Monitoring

$500

Side Effects

$500

Total Annual

$51,000

Cost-Effectiveness

POOR

QALYs Gained

1.3

ICER

$180,000/QALY

Cost per Remission

$134,210

Cost per Responder

$68,000

Treatment Outcomes
Primary Outcomes
BASDAI Score6.0/10
-50% (-3.0 points)
ASDAS-CRP Score3.8
-39.5% (-1.5 points)
Total Back Pain (NRS)7.0/10
-50% (-3.5 points)
C-Reactive Protein (CRP)15 mg/L
-66.7% (-10 mg/L)
Secondary Benefits
BASFI Score5.5/10
-45.5% (-2.5 points)
SF-36 Physical Component Summary (PCS)35 points
+22.9% (+8.0 points)
Morning Stiffness Duration120 minutes
-50% (-60 minutes)
Common Side Effects
Upper respiratory tract infections
+20%
Nasopharyngitis
+15%
Nausea
+10%

Clinical Trial Phases:

Phase 3Phase 4
2
Ixekizumab
69% Effectiveness• 91% Confidence• 60% Safety• 8 trials• 8K participants
HIGH EvidenceModerate ValueDose: 160mg subcutaneous (2x80mg) at week 0, then 80mg every 4 weeks
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Lifetime

Response Rate

72%

Remission Rate

32%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

100

Common Side Effects:

Nasopharyngitis: 15%
Upper respiratory tract infections: 12%
Injection site reactions: 10%
Conjunctivitis: 3%
Oral candidiasis: 1%

Annual Cost of Care

Drug Cost

$40,000

Monitoring

$500

Side Effects

$500

Total Annual

$41,000

Cost-Effectiveness

MODERATE

QALYs Gained

1.2

ICER

$150,000/QALY

Cost per Remission

$128,125

Cost per Responder

$56,944

Treatment Outcomes
Primary Outcomes
BASDAI Score6.2/10
-41.9% (-2.6 points)
ASDAS-CRP Score3.8/6
-44.7% (-1.7 points)
C-Reactive Protein (CRP)22 mg/L
-59.1% (-13 mg/L)
Secondary Benefits
BASFI Score5.7/10
-40.4% (-2.3 points)
SF-36 PCS Score37/100
+17.6% (+6.5 points)
Morning Stiffness Duration140 minutes
-50% (-70 minutes)
Common Side Effects
Nasopharyngitis
+15%
Upper respiratory tract infections
+12%
Injection site reactions
+10%

Clinical Trial Phases:

Phase 4
3
Secukinumab
68% Effectiveness• 92% Confidence• 60% Safety• 23 trials• 10K participants
HIGH EvidenceModerate ValueDose: 150mg or 300mg subcutaneous at week 0, 1, 2, 3, then every 4 weeks
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Lifetime

Response Rate

70%

Remission Rate

30%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

100

Common Side Effects:

Nasopharyngitis: 18%
Upper respiratory tract infections: 15%
Diarrhea: 5%
Oral candidiasis: 2%

Annual Cost of Care

Drug Cost

$38,000

Monitoring

$500

Side Effects

$500

Total Annual

$39,000

Cost-Effectiveness

MODERATE

QALYs Gained

1.1

ICER

$140,000/QALY

Cost per Remission

$130,000

Cost per Responder

$55,714

Treatment Outcomes
Primary Outcomes
BASDAI (Bath Ankylosing Spondylitis Disease Activity Index)6.0/10
-41.67% (-2.5 points)
ASDAS-CRP (Ankylosing Spondylitis Disease Activity Score - C-Reactive Protein)3.8
-47.37% (-1.8 points)
C-Reactive Protein (CRP)15 mg/L
-60% (-9 mg/L)
Total Back Pain (VAS)65 mm (0-100)
-46.15% (-30 mm)
Secondary Benefits
BASFI (Bath Ankylosing Spondylitis Functional Index)5.5/10
-32.73% (-1.8 points)
ASQoL (Ankylosing Spondylitis Quality of Life)11/18
-36.36% (-4 points)
SF-36 Physical Component Summary (PCS)38/100
+15.79% (+6 points)
Common Side Effects
Nasopharyngitis
+18%
Upper respiratory tract infections
+15%
Diarrhea
+5%

Clinical Trial Phases:

Phase 4
4
Adalimumab
65% Effectiveness• 95% Confidence• 60% Safety• 68 trials• 30K participants
HIGH EvidenceModerate ValueDose: 40mg every other week subcutaneous
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Lifetime

Response Rate

65%

Remission Rate

25%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

75

Common Side Effects:

Injection site reactions: 15%
Upper respiratory tract infections: 25%
Sinusitis: 10%
Urinary tract infection: 5%
Serious infections: 3%
Reactivation of latent TB/Hepatitis B: 0.5%

Annual Cost of Care

Drug Cost

$30,000

Monitoring

$500

Side Effects

$500

Total Annual

$31,000

Cost-Effectiveness

MODERATE

QALYs Gained

1

ICER

$120,000/QALY

Cost per Remission

$124,000

Cost per Responder

$47,692

Treatment Outcomes
Primary Outcomes
BASDAI Score5.5 (0-10 scale, higher is worse)
-45.5% (-2.5 points)
ASDAS-CRP Score3.8 (active disease score, higher is worse)
-47.4% (-1.8 points)
C-Reactive Protein (CRP)20 mg/L
-70% (-14 mg/L)
Secondary Benefits
SF-36 Physical Component Summary (PCS)38.0 (0-100 scale, higher is better)
+19.7% (+7.5 points)
BASFI Score5.0 (0-10 scale, higher is worse)
-40% (-2.0 points)
Morning Stiffness Duration150 minutes
-53.3% (-80 minutes)
Common Side Effects
Injection site reactions
+15%
Upper respiratory tract infections
+25%
Sinusitis
+10%

Clinical Trial Phases:

Phase 4
5
Etanercept
63% Effectiveness• 96% Confidence• 60% Safety• 53 trials• 40K participants
HIGH EvidenceModerate ValueDose: 50mg subcutaneous once weekly or 25mg twice weekly
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

Lifetime

Response Rate

68%

Remission Rate

28%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

75

Common Side Effects:

Injection site reactions: 18%
Upper respiratory tract infections: 22%
Headache: 10%
Nausea: 8%
Serious infections: 2.5%

Annual Cost of Care

Drug Cost

$30,000

Monitoring

$500

Side Effects

$500

Total Annual

$31,000

Cost-Effectiveness

MODERATE

QALYs Gained

0.9

ICER

$110,000/QALY

Cost per Remission

$110,714

Cost per Responder

$45,588

Treatment Outcomes
Primary Outcomes
BASDAI (Bath Ankylosing Spondylitis Disease Activity Index)6.5/10
-54% (-3.5 units)
C-reactive protein (CRP)20 mg/L
-70% (-14 mg/L)
Patient Global Assessment of Pain (VAS)75 mm (0-100 mm scale)
-47% (-35 mm)
Secondary Benefits
BASFI (Bath Ankylosing Spondylitis Functional Index)5.5/10
-45% (-2.5 units)
ASQoL (Ankylosing Spondylitis Quality of Life)11/18
-41% (-4.5 points)
BASMI (Bath Ankylosing Spondylitis Metrology Index)4.5/10
-27% (-1.2 units)
Common Side Effects
Injection site reactions
+18%
Upper respiratory tract infections
+22%
Headache
+10%

Clinical Trial Phases:

Phase 4
6
NSAIDs (e.g., Diclofenac, Naproxen)
45% Effectiveness• 90% Confidence• 75% Safety• 1000 trials• 1M participants
HIGH EvidenceExcellent ValueDose: Naproxen 250-500mg BID; Diclofenac 50mg BID/TID or 75mg XR daily/BID
Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
75
DangerousModerateSafe

Time to Effect

Immediate to 1 week

Duration

Lifetime (intermittent or continuous)

Response Rate

75%

Remission Rate

10%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

150

Common Side Effects:

Gastrointestinal upset: 15%
Fluid retention: 5%
Increased blood pressure: 5%
Gastric ulcers/bleeding: 3%
Renal impairment: 1%
Cardiovascular events: 0.5%

Annual Cost of Care

Drug Cost

$200

Monitoring

$100

Side Effects

$100

Total Annual

$400

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

ICER

$1,000/QALY

Cost per Remission

$4,000

Cost per Responder

$533

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+45%
Response Rate
+75%
Remission Rate
+10%
Common Side Effects
Gastrointestinal upset
+15%
Fluid retention
+5%
Increased blood pressure
+5%

Clinical Trial Phases:

Phase 4