Disease modification in ankylosing spondylitis with TNF inhibitors: spotlight on early phase clinical trials.

IntroductionAnkylosing spondylitis (AS) is a chronic inflammatory disease whose main hallmark is involvement of the axial skeleton. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first line treatment; however, their use is limited because of side-effects. Tumour necrosis factor inhibitors (TNFi) are a safe and effective therapy, and they have been approved for the management of AS.Areas coveredThis is a review of the efficacy of TNFi in disease modification in AS. It is focused on results from early phase clinical trials; however, it also discusses the most relevant findings in order to optimise anti-TNF treatment. A literature search was done using PubMed, Medline, Embase, Google Scholar and Cochrane library, looking for scientific publications from inception to August 2021. Further information was retrieved from ClinicalTrial.gov and Clinicaltrialsregister.eu.Expert opinionTNFi have demonstrated short and long-term improvements in all aspects of disease activity, as well as physical function in patients with AS. They have drastically revolutionised the management of the disease; and even though new drugs have become available in the market, TNFi have not been displaced for the treatment of AS, and still constitute the best alternative when NSAIDs are no-longer an option.