title: Emerging drugs for axial spondyloarthritis including ankylosing spondylitis.
abstract: BACKGROUND
  Only non-steroidal anti-inflammatories (NSAIDs) and TNF inhibitors (TNFi) are effective in ankylosing spondylitis (AS). However, not all patients successfully respond to these drugs and a subset may have contraindications to their use.
  
  
  METHODS
  In the last decade, an earlier diagnosis of AS has been achieved due to the increasing availability of MRI. This has led to prompt treatment initiation with improved outcomes. NSAIDs and TNFi are the current treatments for AS which lead to sustained clinical responses in the long term. Recent studies have shown other potential biomarkers in AS, such as the IL-17/IL-23 axis. This has translated into the development of new drugs which interfere with these pathways, such as apremilast and secukinumab, which have shown efficacy in early clinical trials.
  
  
  CONCLUSIONS
  AS carries considerable short- and long-term disabilities. Anti-TNF-α therapies reduce pain, improve function and decrease inflammation as seen by MRI. New treatment options are being developed which may prove efficacious on those patients not responding to anti-TNF. The ultimate research goal should focus on treatments to prevent and stop new bone formation.
authors.affiliation: Hospital General de Granollers, Department of Medicine, Granollers, Spain.
authors.forename: Noemi
authors.initials: N
authors.lastname: Busquets-Perez
authors.forename: Helena
authors.initials: H
authors.lastname: Marzo-Ortega
authors.forename: Paul
authors.initials: P
authors.lastname: Emery
mesh_terms: D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001842:Bone and Bones / Q000187:drug effects / Q000276:immunology / Q000378:metabolism; D002986:Clinical Trials as Topic; D015507:Drugs, Investigational / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007378:Interleukins / Q000037:antagonists & inhibitors / Q000378:metabolism; D007596:Joints / Q000187:drug effects / Q000276:immunology / Q000378:metabolism; D058990:Molecular Targeted Therapy; D010726:Phosphodiesterase Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D025241:Spondylarthritis / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000378:metabolism
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D015507:Drugs, Investigational; D007378:Interleukins; D010726:Phosphodiesterase Inhibitors; D014409:Tumor Necrosis Factor-alpha