title: Therapies of Early, Advanced, and Late Onset Forms of Axial Spondyloarthritis, and the Need for Treat to Target Strategies.
abstract: OBJECTIVE
  This study aims to provide an update on current status of pharmacological therapies in early and advanced stages of axial spondyloarthritis (axSpA), as well as its late onset forms, and to discuss the need for treat to target strategies in this entity.
  
  
  RESULTS
  Efficacy of TNF inhibitors has been assessed in randomized controlled trials in axSpA, which included patients who had non-radiographic axSpA according to the ASAS classification criteria. The role of IL17/23 pathway as a therapeutic target in ankylosing spondylitis (AS) has been the focus of phase III studies of secukinumab (named MEASURE 1 and MEASURE 2) and a proof-of-concept study of ustekinumab. Potential efficacy of novel small molecules such as apremilast and tofacitinib has been explored in recent phase II trials. All the trials of TNF inhibitors in non-radiographic axSpA have achieved their primary endpoints, which resulted in their approval for this indication in Europe, but not in USA. The phase III trials of secukinumab have demonstrated significant therapeutic benefit as compared to placebo, resulting in its approval as the first non-TNF biologic for the treatment of AS, both by the US Food and Drug Administration and the European Medicines Agency.
authors.affiliation: , Izmir, Turkey. nurullah.akkoc@gmail.com.
authors.forename: Nurullah
authors.initials: N
authors.lastname: Akkoc
authors.affiliation: Department of Rheumatology, Dokuz Eylul University, Faculty of Medicine, Balcova, 35340, Izmir, Turkey.
authors.forename: Gercek
authors.initials: G
authors.lastname: Can
authors.affiliation: Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Contrada Macchia Romana, 85100, Potenza, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Angelo
authors.affiliation: Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Contrada Macchia Romana, 85100, Potenza, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Padula
authors.affiliation: Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Contrada Macchia Romana, 85100, Potenza, Italy.|Basilicata Ricerca Biomedica (BRB) Foundation, Potenza and Matera, Italy.
authors.forename: Ignazio
authors.initials: I
authors.lastname: Olivieri
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D006801:Humans; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: Ankylosing spondylitis; Axial spondyloarthritis; DMARDs; IL-17A; NSAIDs; Non-radiographic axial spondyloarthritis; Secukinumab; TNF inhibitors; Treat to target; Treatment