Emerging Treatment Options for Axial Spondyloarthritis

As more research is done, more treatment options for AxSpA spectrum conditions emerge. While there is still no cure for these conditions, the goals of treatment are to maximize quality of life, prevent or slow progressive structural damage, and control symptoms and inflammation and preserve mobility.1

With the classification of non-radiographic axial spondyloarthritis (nr-AxSpA), this allows people living with various kinds of AxSpA spectrum conditions to receive treatment, and paves the way for researchers to do clinical trials and doctors to prescribe medications, as opposed to waiting for a radiographic axial spondyloarthritis (r-AxSpA)/ankylosing spondylitis (AS) diagnosis. Research and clinical trials are being done, with various potential emerging treatment options for the future for AxSpA spectrum conditions.

What are clinical trials and studies?

Clinical research is a mainstay of medicine, and involves medical research using people. There are two kinds of clinical research: observational studies and clinical trials.2

Observational studies are studies that involve observing people in “regular” settings and study the changes that occur over time. They may group study participants by certain characteristics or gather data through exams, tests, or questionnaires.2

Clinical trials are research studies done with people that evaluate a medical, surgical, or behavioral intervention.2 They are the main way that researchers find out if a treatment is safe and/or effective in humans. With new treatments, the clinical trials often look at whether the new treatment is as safe or effective than the current available treatments.2

What does this mean for AxSpA?

Research and clinical trials are constantly being done regarding AxSpA, and this means that the future treatment options may be expanding, especially for nr-AxSpA. Right now, there are more drugs approved to treat ankylosing spondylitis than for nr-AxSPA, but that might change in the future due to the research being done.

Bimekizumab is a biologic drug that is being studied for both ankylosing spondylitis (AS) and nr-AxSpA. Bimekizumab is an antibody that blocks the activity of two different interleukins: IL-17A and IL-17F.5 These are two proteins that stimulate inflammation in AS.5 In a Phase 2b trial of the drug, participants with AS showed sustained improvements in global assessment of disease, pain, function, and inflammation.5

Another study currently being done is looking at people with either psoriatic arthritis, AS, or nr-AxSpA and the drug tildrakizumab.6 Tildrakizumab (brand name Ilumya) is a biologic that blocks IL-23, which plays a role in inflammatory pathways.7

Existing treatments

Some drugs approved for AS but not yet approved for nr-AxSpA are used off-label by some doctors for AxSpA, and many of these drugs have also been effective in treating signs and symptoms of nr-AxSpA spectrum conditions.8 More studies should be done in looking at these drugs and their effectiveness for those with nr-AxSpA.

For those with nr-AxSpA who cannot take a TNF inhibitor, drugs that inhibit IL-17 like secukinumab may be helpful, and so the clinical trials for that are especially important.8

Things to think about

Talk with your doctor about emerging treatment options. Your doctor should be aware of any potential treatments that may be a possibility for you and your AxSpA spectrum condition. If you’re interested in participating in a clinical study, let your doctor know. If they are aware of any clinical studies that are nearby and recruiting, they can let you know about them.

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Written by: Jaime Rochelle Herndon | Last reviewed: November 2020