An update in the pharmacological management of axial spondyloarthritis

Expert Opin Pharmacother. 2024 Jun;25(8):957-971. doi: 10.1080/14656566.2024.2363489. Epub 2024 Jun 3.

Abstract

Introduction: Significant progress has been made in the diagnosis and management of axial spondyloarthritis (AxSpA) over recent decades. A greater understanding of the immunopathogenesis of the disease has paved the way for the development of targeted treatments. Their efficacy has been demonstrated in randomized controlled trials, meta-analyses and one head-to-head study of biologic DMARDs. Treatment decisions in AxSpA are currently influenced by patient choice, co-morbidity, clinician familiarity and cost.

Areas covered: We review the clinical trials that underpin the evidence base for treatments in AxSpA. We also cover the meta-analyses and head-to-head data that seek to support clinicians in personalizing treatment decisions. Further, we discuss the recent international guidelines that provide clinicians with treatment pathways and guidance.

Expert opinion: We conclude that treatment decisions in managing both radiographic and non-radiographic AxSpA should be based on shared decision-making with patients, the clinical effectiveness of drug class, co-morbidity and cost. At present, we have limited head-to-head data to prioritize one drug class over another for first-line treatment but can recommend tumor necrosis factor (TNF), interleukin 17 (IL17) and JAK inhibition as being comparable in terms of clinical, structural and patient-reported outcome measures. Further real-world data may guide treatment decision-making in individual patients.

Keywords: AS; AxSpA; IL17i; JAKi; Nr-AxSpA; TNFi; axial spondyloarthritis; r-AxSpA.

Publication types

  • Review

MeSH terms

  • Antirheumatic Agents* / therapeutic use
  • Axial Spondyloarthritis* / drug therapy
  • Biological Products / therapeutic use
  • Clinical Decision-Making
  • Decision Making, Shared
  • Humans
  • Practice Guidelines as Topic
  • Randomized Controlled Trials as Topic

Substances

  • Antirheumatic Agents
  • Biological Products