Toxicological considerations in the treatment of axial spondylo-arthritis

ABSTRACT

Introduction

The first-line treatment of axial spondyloarthritis (SpA) is with non-steroidal anti-inflammatory drugs (NSAIDs) and is followed by tumor necrosis factor (TNF) inhibitors (the main treatment for patients not responding to NSAIDs) or drugs targetting the IL-23/IL-17 pathway. The efficacy of disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate and sulfasalazine (SSZ) has not been demonstrated, although SSZ can be considered in patients with concomitant peripheral arthritis.

Areas covered

This review describes the beneficial and toxicological effects of the drugs used to treat axial SpA.

Expert commentary

Growing concerns about the safety of anti-TNF drugs underline the need to ensure that all clinicians are capable of taking appropriate preventive action and adequately treating affected patients.

KEYWORDS:

• Axial SpA
• cardiovascular disease
• infections
• anti-TNF drugs
• anti-IL17 drugs

Article highlights

• Anti-TNF drugs can increase the risk of infections, cardiovascular and neurological diseases, and anti-drug antibodies

• Anti-TNF drugs reduce inflammation in SpA patients.

• The increased risk of adverse events among SpA patients receiving anti-TNF treatment can be avoided by screening all patients before starting its administration.

• Anti-IL17 drugs are efficacious drugs but some adverse events can be observed.

This box summarizes key points contained in the article.

Author-contributions

F Marino, IF Masala, V Nucera, E Gerratana, M Giallanza and L La Corte participated in the literature search. F Atzeni, F Marino, S D’Angelo, IF drafted the manuscript, which was critically reviewed by P Sarzi-Puttini, S D’Angelo and F Atzeni.

All authors read and approved the final manuscript.

Declaration-of-interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Reviewer-disclosures

A reviewer of this manuscript has acted as consultant or participated in speaker’s bureau for AbbVie, Bristol Myers Squibb, Chugai, Eli Lilly, Nordic, Novartis, Pfizer, Sanofi and UCB Pharma. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

This-paper was not funded.