Abstract

TNF-blockers have been proven to be highly effective in patients with axial spondyloarthritis (axSpA) including patient with anklyosing spondylitis (AS) and non-radiographic axial SpA (nr-axSpA) who show an inadaequate response to conventional treatment. However, there is further need for additional treatment options because (i) about 30% of the patients treated do not reach an ASAS 20 response, and the drop out rate per year is about 15-20%, mostly because of side effects and/or secondary inefficacy. Furthermore, conventional DMARDs such as methotrexate or sulfasalazine are not effective, and the majority of axSpA patients relapse once TNF-blocker treatment is interrupted. On this background new treatment targets are of great interest. Biologics directed against T cells, B cells and directed against various cytokines such as IL-1, IL-6, IL-17 and against the p40chain of IL23 and IL-12 have been tested or are being tested in patients with AS, often in small studies. Therapeutic trials with new small molecules are being planned. The rationale for the selection of these targets and the treatment results will be presented and future development will be discussed. Until now, there is still an unmet need for the treatment of axSpA patients who fail NSAIDs and TNF-blocker treatment.