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Biological and targeted therapy in axial spondyloarthritis: 2024 update

Czech version

Authors: K. Pavelka
Authors‘ workplace: Revmatologický ústav Praha
Published in: Čes. Revmatol., 33, 2025, No. 1, p. 7-17.
Category: Reviews

Overview

The concept of spondyloarthritis (SpA) continues to evolve rapidly across all dimensions, including early diagnosis, disease activity assessment, prognostic evaluation, predictive markers of therapeutic response, novel pharmacologic agents, treatment strategies, structural progression, imaging modalities, and treatment safety.

The therapeutic landscape for axial spondyloarthritis (axSpA) has significantly expanded and now includes three major classes of agents: tumor necrosis factor (TNF) inhibitors, interleukin-17 (IL-17) inhibitors, and Janus kinase (JAK) inhibitors. Drug selection is based on the specific form of axSpA, disease activity, domain involvement, extra-musculoskeletal manifestations, and comorbid conditions. The 2022 EULAR recommendations guide current treatment strategies. For first-line biologic therapy, both TNF and IL-17 inhibitors are considered equally effective. TNF inhibitors are generally preferred in patients with extra-musculoskeletal manifestations such as uveitis or inflammatory bowel disease, whereas IL-17 inhibitors are more suitable for patients with prominent psoriasis. JAK inhibitors are typically recommended as second-line therapy following inadequate response to first-line agents, primarily due to limited long-term safety data. Recently approved therapies for axSpA include the dual IL-17A/F inhibitor bimekizumab, the pan-JAK inhibitor tofacitinib (JAK1–3), and the selective JAK1 inhibitor upadacitinib.

Keywords:

biological therapy – axial spondyloarthritis – targeted treatment

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Dermatology & STDs Paediatric rheumatology Rheumatology
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Subcutaneous belimumab
A new option for pain management in rheumatic diseases
Jubilarians of the Czech Society of Rheumatology in 2025
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