Evidence Supports TNF and IL-17 Inhibitors in the Treatment of Axial Spondyloarthritis

Evidence supports the use of tumor necrosis factor inhibitors (TNFi) and interleukin 17 inhibitors (IL-17i), and does not support the use of interleukin 23 inhibitors (IL-23i), in the management of patients with axial spondyloarthritis (axSpA), according to a review paper published in Annals of the Rheumatic Diseases.

Researchers conducted a systematic review of the literature from 2016 to 2021 to inform the 2022 recommendations of the Assessment of Spondyloarthritis International Society/European Alliance of Associations for Rheumatology (ASAS-EULAR) for the management of axSpA.

A total of 148 studies, including randomized controlled trials, strategy trials, and observational studies, were included in the analysis.

Studies confirmed the superior efficacy of several IL-17i, including secukinumab, ixekizumab, bimekizumab, netakimab, and brodalumab, vs placebo in patients with radiographic axSpA (r-axSpA) and nonradiographic axSpA (nr-axSpA). .

The literature also confirmed the equivalence of biosimilar and TNFi. In addition, tapering of TNFi by spacing compared with standard-dose treatment did not result in inferior outcomes, demonstrating sustained remission of axSpA.

The literature did not support the use of IL-23i and IL-12/23i, such as risankizumab and ustekinumab, which were found to be largely ineffective among patients with axSpA.

Incidence of cardiovascular events, infections, and malignancy, as well as irritable bowel disease, psoriasis, and acute anterior uveitis, was low in patients with axSpA receiving treatment with IL-17i and TNFi. However, according to observational studies, treatment of axSpA with secukinumab and etanercept compared with monoclonal TNFi increased risk for anterior uveitis.

Limitations included the lack of studies assessing safety of IL-17 inhibitors and high risk of bias among the majority of the observational studies.

“This review informed the 2022 ASAS-EULAR management recommendations for axSpA, highlighting new evidence on efficacy and safety of existing and new bDMARDs,” the authors of the paper concluded.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.