Nonradiographic axial spondyloarthritis (SpA) and radiographic SpA (also known as ankylosing spondylitis) are currently considered as two stages or forms of one disease (axial SpA). The treatment with tumor necrosis factor-α (TNFα) inhibitors has been authorized for years for ankylosing spondylitis. In recent years, most of the anti-TNFα agents have also been approved for the treatment of nonradiographic axial SpA by the European Medicines Agency (EMA) and similar authorities in many countries around the world (but not in the US), increasing the number of possible therapies for this indication. Data from several clinical trials have demonstrated the good efficacy and safety profiles from those anti-TNFα agents. Presently, a large number of patients achieve a satisfactory clinical control with the current therapies, however, there remains a percentage refractory to nonsteroidal anti-inflammatory drugs (NSAIDs) and TNFα inhibitors; therefore, several new drugs are currently under investigation. In 2015, the first representative of a new class of biologics [an interleukin (IL)-17 inhibitor] secukinumab, was approved for the treatment of ankylosing spondylitis; a clinical trial in nonradiographic axial SpA is currently underway. In this review, we discuss the recent data on efficacy and safety of TNFα-inhibitors focusing on the treatment of nonradiographic axial SpA.
Keywords: TNFα; spondyloarthritis; treatment.
Conflict of interest statement
Conflict of interest statement: VR: none declared; DP: received grant/research support from AbbVie, MSD, Novartis, Pfizer; consultant for: AbbVie, BMS, Boehringer, MSD, Novartis, Pfizer, and UCB; speakers bureau: AbbVie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.
Brief Report: Clinical Course Over Two Years in Patients With Early Nonradiographic Axial Spondyloarthritis and Patients With Ankylosing Spondylitis Not Treated With Tumor Necrosis Factor Blockers: Results From the German Spondyloarthritis Inception Cohort.Arthritis Rheumatol. 2015 Sep;67(9):2369-75. doi: 10.1002/art.39225. Arthritis Rheumatol. 2015. PMID: 26017497
Tumor necrosis factor α inhibition in radiographic and nonradiographic axial spondyloarthritis: results from a large observational cohort.Arthritis Rheum. 2013 Dec;65(12):3096-106. doi: 10.1002/art.38140. Arthritis Rheum. 2013. PMID: 23983141
Golimumab in radiographic and nonradiographic axial spondyloarthritis: a review of clinical trials.Drug Des Devel Ther. 2016 Jul 1;10:2087-94. doi: 10.2147/DDDT.S107587. eCollection 2016. Drug Des Devel Ther. 2016. PMID: 27445459 Free PMC article. Review.
Golimumab for treatment of axial spondyloarthritis.Immunotherapy. 2016 Feb;8(2):107-15. doi: 10.2217/imt.15.112. Epub 2016 Jan 22. Immunotherapy. 2016. PMID: 26798943 Review.
Biologics in spondyloarthritis: TNFα inhibitors and other agents.Immunotherapy. 2015;7(6):669-81. doi: 10.2217/imt.15.28. Epub 2015 Jun 10. Immunotherapy. 2015. PMID: 26058432 Review.
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