Emerging drugs for the treatment of axial and peripheral spondyloarthritis

Abstract

Introduction: The topic under discussion is of strong relevance to the field of spondyloarthritis (SpA) because, in addition to established biological, there are new promising compounds. The reason for the review is to put all available data together to allow for an overview on recent developments and to especially inform readers about emerging drugs, biologics and small molecules in the field of SpA.

Areas covered: This review on new therapies in axial and peripheral SpA comprising psoriatic arthritis (PsA) shows, that, in addition to the established anti-TNF agents infliximab, etanercept, adalimumab, golimumab, certolizumab and the first biosimilar approved in the EU, there are at least two emerging biologics in the field of SpA: ustekinumab, a compound targeting IL12/IL-23 via the p40 subunit of both cytokines works for psoriasis and PsA and probably also for Crohn’s disease, and the anti-IL-17 antibody secukinumab which has also been shown to work in psoriasis, both compounds seem to also work in ankylosing spondylitis. In addition, the potential of two small molecules, apremilast a phoshodiesterase4 inhibitor and tofacitinib, a januskinase inhibitor is discussed.

Expert opinion: Since, in contrast to rheumatoid arthritis, the therapeutic array in SpA is currently limited to TNF-blockers, and since there is still an unmet need because some patients do not respond to anti-TNF therapy at all or they loose response, new agents with a different mechanism of action are eagerly awaited.

Keywords:

• axial spondyloarthritis
• Interleukin-23
• peripheral spondyloarthritis
• spondyloarthritis
• T_H17 pathway
• TNF-antagonists

Declaration of interest

J Braun has received honoraria for talks, advisory boards, paid consultancies and grants for studies from Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Janssen, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis and UCB. U Kiltz has received grant and research support and consultancy fees from AbbVie, MSD, Pfizer, Roche and UCB. F Heldmann has received honoraria for advisory boards from UCB, Chugai, and Jannsen-Cilag and has received honoraria for talks from UCB, Chugai and Roche. X Baraliakos has received grant and research support and consultancy fees from AbbVie (Abbot), Amgen, Centocor, Chugai, MSD, Novartis, Pfizer, UCB and Wyeth. 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.