Table 2.
Approved pharmacological treatment options for axSpA
| Treatment | Administration | EMA approval | FDA approval | ||
|---|---|---|---|---|---|
| AS | nr-axSpA | AS | nr-axSpA | ||
| TNF inhibitor a | |||||
| Adalimumab | 40 mg SC q2w | ✓ | ✓ | ✓ | – |
| Certolizumab pegol | 200 mg SC q2w or 400 mg SC q4w | ✓ | ✓ | ✓ | ✓ |
| Etanercept | 50 mg SC qw | ✓ | ✓ | ✓ | – |
| Golimumab | 50 mg SC q4w; 2 mg/kg IV at weeks 0 and 4, then q8w thereafter | ✓ | ✓ | ✓ | – |
| Infliximab | 5 mg/kg IV at weeks 0, 2, and 6, then q6w thereafter | ✓ | – | ✓ | – |
| IL-17 inhibitor b | |||||
| Ixekizumab |
AS: 160 mg SC at week 0, then 80 mg q4w thereafter nr-axSpA: 80 mg SC q4w |
✓ | ✓ | ✓ | ✓ |
| Secukinumab |
With loading dose: 150 mg SC at weeks 0, 1, 2, 3, and 4, then q4w thereafter Without loading dose: 150 mg SC q4wc |
✓ | ✓ | ✓ | ✓ |
| Bimekizumab | 160 mg SC q4w | ✓ | ✓ | – | – |
| JAK inhibitor | |||||
| Tofacitinib | 5 mg oral bid | ✓ | – | ✓ | – |
| Upadacitinib | 15 mg oral qd | ✓ | ✓ | ✓ | ✓ |
a TNFi inhibitor monoclonal antibodies are recommended over other bDMARDs for patients with a history of uveitis or active IBD
b IL-17 inhibitors may be preferred to other bDMARDs for patients with significant psoriasis but are not recommended in patients with active IBD
c For patients with active AS despite treatment with secukinumab 150 mg, increasing the dose to 300 mg may be considered
AS, ankylosing spondylitis; axSpA, axial spondyloarthritis; bid, twice a day; EMA, European Medicines Agency; FDA, US Food and Drug Administration; IL-17, interleukin 17; IV, intravenously; nr-axSpA, non-radiographic axial spondyloarthritis; q2w, every 2 weeks; q4w, every 4 weeks; q6w, every 6 weeks; q8w, every 8 weeks; qd, once daily; qw, once weekly; SC, subcutaneously; TNF, tumour necrosis factor