Biologics for treating axial spondyloarthritis

ABSTRACT

Introduction: Spondyloarthritis (SpA) encompasses a heterogeneous group of diseases sharing genetic, immunological, clinical and imaging features. Axial spondyloarthritis (axSpA) refers to a subgroup characterised predominately by inflammation of the axial skeleton with subsequent symptoms of chronic (often inflammatory) back pain and sacroiliitis. There is a strong association with the major histocompatibility complex (MHC) class I allele human leukocyte antigen (HLA) B27. In the last decade, there has been significant progress in earlier detection of the disease and the molecular mechanisms involved in its pathogenesis. The subsequent introduction of anti-tumour necrosis factor (TNF) has revolutionised the treatment of patients with axSpA.

Areas covered: In this article, we review the current biologic therapies for axSpA, the emergence of biosimilars, predictors of response, primary and secondary failure and new biologics on the horizon.

Expert opinion: There have been significant advances in the treatment of axSpA. Beyond the clear efficacy of anti-TNF inhibition, IL-17 offers an alternative therapeutic target and there is promise from inhibition of the IL-17/IL-23 pathway and small molecules, such as Janus kinase (JAK) inhibitors. Biosimilars have offered greater affordability and choice within this increasingly growing field of therapeutics.

KEYWORDS:

• Spondyloarthritis
• ankylosing spondylitis
• biologics
• anti-TNF
• anti-IL17
• biosimilars

Article highlights

Biologics in axial spondyloarthritis

• Significant advances have been made in the treatment of axSpA.

• Despite the efficacy of biologics, NSAIDs continue to be the first-line treatment for patients with axSpA, and non-pharmacological treatment modalities continue to be important in the management of these patients.

• For the first time in many years a new therapeutic approach has been approved (targeting IL-17) and others show promise in axSpA.

• The introduction of biosimilars has greatly reduced the cost associated with biologic treatment.

• Trying to establish which patients benefit the most from each drug is a challenge for the future.

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Declaration of interest

PM Machado has consultancy/speaker fees from AbbVie, Centocor, Janssen, MSD, Novartis, Pfizer and UCB Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. One peer reviewer has been a speaker or consultant for all companies that currently market a biological treatment in the field (all fees are collected by the reviewer’s university’s tech transfer department and are not a direct part of the reviewer’s income). Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose

Additional information

Funding

PM Machado was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre for this paper.