Biologic therapies for the treatment of ankylosing spondylitis

Abstract

Ankylosing spondylitis (AS) is a chronic inflammatory disease predominantly affecting the axial skeleton. AS treatment aims to reduce pain and inflammation and maintain functional capacity. Nonsteroidal anti-inflammatory drugs are the first-line treatment for those with active AS. While for peripheral arthritis, sulfasalazine or local glucocorticoid injection can be used, these are not recommended for axial symptoms. Twenty years ago, biological products that target the tumor necrosis factor (TNF) were developed. These have been approved for use in rheumatoid arthritis and AS. Since the introduction of these TNF inhibitors, the control of disease activity in AS has improved markedly. TNF inhibitors, including both anti-TNF-alpha monoclonal antibodies and recombinant TNF soluble receptors, can be considered for patients with persistently active disease despite nonsteroidal anti-inflammatory drug treatment. Recently, interleukin-17 inhibitors have also been approved for use in AS patients with insufficient responses to TNF inhibitors. Ongoing clinical trials are exploring the effect of Janus kinase inhibitors against AS. This review summarizes the current pharmaceutical treatment for AS, focusing on the biological products. Recommendations for AS management are also discussed in this review.