Tumor necrosis factor alpha antagonists in the treatment of axial spondyloarthritis.

INTRODUCTION: The introduction of therapy with tumor necrosis factor antagonists (aTNF) was a cornerstone of treatment modalities in patients with ankylosing spondylitis (AS). After > 10 years of using aTNF, the introduction of aTNF therapy was a major step forward in the medical management of patients with spondyloarthritis (SpA), but there are still a number of scientific questions that have not been resolved. AREAS COVERED: This review includes both subtypes of axial spondyloarthritis (axSpA), non-radiographic axial SpA (nr-axSpA), and AS. It covers all five aTNF adalimumab, certolizumab, etanercept, golimumab, and infliximab, which are approved for patients with active AS. EXPERT OPINION: aTNF are efficacious and effective in reducing signs and symptoms of patients with axSpA. While aTNF reduce spinal inflammation, the effects on new bone formation are less clear. There may be a deceleration of radiographic progression in 4 years. The development of fatty lesions in vertebral edges seems to be relevant for that - especially when inflammation also persists. Reduction of aTNF doses seems to be possible in selected patients over time. In case of failure, switching to another aTNF works in the majority of cases. Long-term data suggest a favorable safety profile of aTNF.