title: Emerging drugs for the treatment of axial and peripheral spondyloarthritis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Rheumazentrum Ruhrgebiet , Claudiusstr. 45, 44649 Herne , Germany +49 2325 592131 ; +49 2325592136 ; j.braun@rheumazentrum-ruhrgebiet.de.
authors.forename: Juergen
authors.initials: J
authors.lastname: Braun
authors.forename: Uta
authors.initials: U
authors.lastname: Kiltz
authors.forename: Frank
authors.initials: F
authors.lastname: Heldmann
authors.forename: Xenofon
authors.initials: X
authors.lastname: Baraliakos
mesh_terms: D000818:Animals; D018501:Antirheumatic Agents / Q000494:pharmacology / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy* / Q000503:physiopathology; D015195:Drug Design; D006801:Humans; D007155:Immunologic Factors / Q000494:pharmacology / Q000627:therapeutic use; D025241:Spondylarthritis / Q000188:drug therapy* / Q000503:physiopathology; D013167:Spondylitis, Ankylosing / Q000188:drug therapy* / Q000503:physiopathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha
keywords: Interleukin-23; TH17 pathway; TNF-antagonists; axial spondyloarthritis; peripheral spondyloarthritis; spondyloarthritis