Amid Effective TNF-α Inhibitors, What Clinical Improvements Do Rheumatologists and Payers Expect from Emerging Therapies with a Different Mechanism of Action?
Axial spondyloarthritis (Ax SpA) is a chronic inflammatory disease of the axial skeleton (sacroiliac joints and spine) that results in chronic back pain and stiffness. Ankylosing spondylitis (AS) is a type of Ax SpA with radiographic abnormalities of the sacroiliac joint; nonradiographic Ax SpA is a type of Ax SpA with no evidence of structural damage but the signs and symptoms of Ax SpA. Key treatment goals for Ax SpA include improving signs and symptoms of the disease, improving physical function, slowing or preventing structural damage, and improving the patient’s quality of life. Treatment of moderate to severe disease is dominated by tumor necrosis factor-alpha (TNF-α ) inhibitors; however, the market is poised to expand with the anticipated approval of novel biologic and oral small-molecule therapies that will attempt to compete with the established therapies on the basis of novel mechanisms of action, efficacy, safety, and/or differences in formulation and dosing frequency.