Developments with experimental and investigational drugs for axial spondyloarthritis

ABSTRACT

Introduction: Axial spondyloarthritis (AxS pA) is a chronic inflammatory disease for which, until recently, there were no valid therapeutic alternatives to TNF-α blocking agents. This unmet clinical need led to explore several therapeutic targets, from proinflammatory cytokines to intracellular signaling systems. The recent approval of Secukinumab, an anti-IL-17A monoclonal antibody, marked a new step in the evolution of AxSpA treatment.

Areas covered: the authors review and discuss all the biological or synthetic agents that are currently developed or that have been tested in AxSpA. News from relevant press releases by manufacturers on past, current and future developments are also reported. Several agents that target IL-17 are currently between phase 2 and 3 of clinical development. Ustekinumab, a monoclonal antibody that blocks IL-23 and IL-12 is also in phase 3 after encouraging results from a pilot study.

Expert opinion: The advent of agents that target the IL-23/IL-17 axis promises to reshape the therapeutic landscape for AxSpA in the next few years. Open questions in the research agenda for these agents involve their positioning in the therapeutic strategy, their efficacy on the spectrum of skeletal and extraskeletal manifestations of AxSpA, their effect on new bone formation and their long-term tolerance.

KEYWORDS:

• Axial spondyloarthritis
• investigational drugs
• interleukin-17
• interleukin-23
• ixekizumab
• bimekizumab
• BCD-085

Article highlights

• Around 40% of patients with axial spondyloarthritis (AxSpA) do not respond, are intolerant, or present contraindications to anti-TNF agents. Until recently, no effective therapeutic options were available for these patients.

• Agents that block the IL-23/IL-17 axis are now available with clinical response rates comparable to anti-TNF agents and proven efficacy even in patients that have not responded to anti-TNF treatment.

• Several new anti IL-12/23 and anti-IL-17 agents are between phase 2 and 3 of clinical development in AxSpA, and are likely to provide valuable therapeutic alternatives to anti-TNF treatments in the near future.

• Ongoing trials with head-to-head comparison with anti-TNF agents, and in patients with precocious disease (non radiologic AxSpA) will help to define place of these new agents in the therapeutic strategy for AxspA.

• Oral synthetic molecules like apremilast a phosphadiesterase4 inhibitor, were deceiving in AxSpA. Tofacitinib, a pan-JAK inhibitor, was effective in a phase 2 study but will not be further developed for this indication.

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Declaration of interest

G. Clavel has received a speaker’s fees from Eli Lilly. L. Semerano has received unrestricted research grants from Pfizer; speaker’s fees from Pfizer and Roche and congress invitations from Roche, MSD and Bristol-Myers Squibb. J. Sigaux has received speaker’s fees from Bristol-Myers Squibb and congress invitation from MSD. M-C. Boissier has received unrestricted research grants from Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.