{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T23:14:52Z","timestamp":1768950892337,"version":"3.49.0"},"reference-count":61,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T00:00:00Z","timestamp":1690502400000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2023,7,15]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The objective of this systematic review was to provide an overview of current developments and potentially available therapeutic options for spondyloarthritis (SpA) in the coming years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a systematic review of 17 national and international clinical trial databases for all disease-modifying antirheumatic drugs (DMARDs) for SpA that are already marketed, in clinical development or withdrawn. The search was performed on February 2023 with the keywords \u201cspondyloarthritis\u201d, \u201cankylosing spondylitis\u201d and \u201cpsoriatic arthritis\u201d. For each molecule, we only considered the study at the most advanced stage of clinical development.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Concerning axial SpA (axSpA), a total of 44 DMARDs were identified: 6 conventional synthetic DMARDs (csDMARDs), 27 biological DMARDs (bDMARDs) and 11 targeted synthetic DMARDs (tsDMARDs). Among the 18 targeted treatments (b+tsDMARDs) in current development, corresponding trials reached phase I (n=1), II (n=10) and III (n=7). Ten molecules are IL-17 inhibitors, two Janus kinase (JAK) inhibitors and two granulocyte-macrophage colony-stimulating factor inhibitors; four have another mode of action. Concerning psoriatic arthritis (PsA), 44 DMARDs were identified: 5 csDMARDs, 27 bDMARDs and 12 tsDMARDs. Among the 15 molecules in current development, corresponding trials reached phase II (n=8) and III (n=7). Six molecules are JAK inhibitors, six IL-17 inhibitors and one an IL-23 inhibitor; two have another mode of action.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This systematic review identified 18 and 15 molecules in clinical development for axSpA and PsA, respectively, which suggests a strengthening of the therapeutic arsenal in the coming years. However, with so many DMARDs but low target diversity, we will need to develop strategies or biomarkers to help clinicians make informed treatment decisions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2023-003279","type":"journal-article","created":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T13:01:10Z","timestamp":1690549270000},"page":"e003279","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["The 2023 pipeline of disease-modifying antirheumatic drugs (DMARDs) in clinical development for spondyloarthritis (including psoriatic arthritis): a systematic review of trials"],"prefix":"10.1136","volume":"9","author":[{"given":"Agathe","family":"Denis","sequence":"first","affiliation":[{"name":"Service de Rhumatologie de Hautepierre, RESO, Centre de R\u00e9f\u00e9rence des Maladies Autoimmunes Syst\u00e9miques Rares Est Sud-Ouest, H\u00f4pitaux Universitaires de Strasbourg, Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C\u00e9dric","family":"Sztejkowski","sequence":"additional","affiliation":[{"name":"Service de Rhumatologie de Hautepierre, RESO, Centre de R\u00e9f\u00e9rence des Maladies Autoimmunes Syst\u00e9miques Rares Est Sud-Ouest, H\u00f4pitaux Universitaires de Strasbourg, Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8077-8394","authenticated-orcid":false,"given":"Laurent","family":"Arnaud","sequence":"additional","affiliation":[{"name":"Service de Rhumatologie de Hautepierre, RESO, Centre de R\u00e9f\u00e9rence des Maladies Autoimmunes Syst\u00e9miques Rares Est Sud-Ouest, H\u00f4pitaux Universitaires de Strasbourg, Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guillaume","family":"Becker","sequence":"additional","affiliation":[{"name":"P\u00f4le Pharmacie-Pharmacologie, H\u00f4pitaux universitaires de Strasbourg, Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4951-4032","authenticated-orcid":false,"given":"Renaud","family":"Felten","sequence":"additional","affiliation":[{"name":"Service de Rhumatologie de Hautepierre, RESO, Centre de R\u00e9f\u00e9rence des Maladies Autoimmunes Syst\u00e9miques Rares Est Sud-Ouest, H\u00f4pitaux Universitaires de Strasbourg, Strasbourg, France"},{"name":"Centre d\u2019Investigation Clinique, Inserm 1434, INSERM, Strasbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,7,28]]},"reference":[{"key":"2025090312015168000_9.3.e003279.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jbspin.2022.105468","article-title":"Challenges in non-radiographic axial Spondyloarthritis","volume":"90","author":"Poddubnyy","year":"2023","journal-title":"Joint Bone Spine"},{"key":"2025090312015168000_9.3.e003279.2","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223296"},{"key":"2025090312015168000_9.3.e003279.3","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2020-217159"},{"key":"2025090312015168000_9.3.e003279.4","article-title":"2022 French society for rheumatology (SFR) recommendations on the everyday management of patients with Spondyloarthritis, including Psoriatic arthritis","volume":"89","author":"Wendling","year":"2022","journal-title":"Joint Bone Spine"},{"key":"2025090312015168000_9.3.e003279.5","doi-asserted-by":"crossref","first-page":"3158","DOI":"10.1093\/rheumatology\/keaa268","article-title":"Effect of biologic disease-modifying anti-rheumatic drugs targeting remission in axial Spondyloarthritis: systematic review and meta-analysis","volume":"59","author":"Cruz-Machado","year":"2020","journal-title":"Rheumatology (Oxford)"},{"key":"2025090312015168000_9.3.e003279.6","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2011-301668"},{"key":"2025090312015168000_9.3.e003279.7","doi-asserted-by":"crossref","DOI":"10.1111\/sji.12946","article-title":"The TNF\/IL-23\/IL-17 axis-head-to-head trials comparing different Biologics in psoriasis treatment","volume":"92","author":"Ten Bergen","year":"2020","journal-title":"Scand J Immunol"},{"key":"2025090312015168000_9.3.e003279.8","doi-asserted-by":"crossref","DOI":"10.1016\/j.jbspin.2023.105523","article-title":"New Biologics and targeted therapies in systemic lupus: from new molecular targets to new indications. A systematic review","volume":"90","author":"Felten","year":"2023","journal-title":"Joint Bone Spine"},{"key":"2025090312015168000_9.3.e003279.9","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204317"},{"key":"2025090312015168000_9.3.e003279.10","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s10067-020-05207-z","article-title":"Molecular mechanisms and clinical studies of Iguratimod for the treatment of Ankylosing Spondylitis","volume":"40","author":"Liu","year":"2021","journal-title":"Clin Rheumatol"},{"key":"2025090312015168000_9.3.e003279.11","doi-asserted-by":"crossref","unstructured":"Chen X , Wang W , Xue J . Efficacy and safety of iguratimod combined with celecoxib in active axial spondyloarthritis: a randomized, double-blind, placebo-controlled study. In Review [Preprint] 2023. doi:10.21203\/rs.3.rs-2806160\/v1","DOI":"10.21203\/rs.3.rs-2806160\/v1"},{"key":"2025090312015168000_9.3.e003279.12","doi-asserted-by":"crossref","first-page":"1778","DOI":"10.1002\/art.40579","article-title":"Phase II study of ABT-122, a tumor necrosis factor\u2013 and Interleukin-17A\u2013targeted dual variable domain immunoglobulin, in patients with Psoriatic arthritis with an inadequate response to methotrexate","volume":"70","author":"Mease","year":"2018","journal-title":"Arthritis Rheumatol"},{"key":"2025090312015168000_9.3.e003279.13","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/key312"},{"key":"2025090312015168000_9.3.e003279.14","doi-asserted-by":"crossref","first-page":"376","DOI":"10.47360\/1995-4484-2020-376-386","article-title":"Efficacy and safety of Netakimab, anti-IL-17A Monoclonal antibody, in patients with Ankylosing Spondylitis. results of phase III International, multicenter, randomized double-blind clinical trial BCD-085-5\/ASTERA","volume":"58","author":"Mazurov","year":"2020","journal-title":"Nau\u010dno-Prakti\u010deska\u00e2 Revmatologi\u00e2"},{"key":"2025090312015168000_9.3.e003279.15","doi-asserted-by":"crossref","first-page":"47","DOI":"10.47360\/1995-4484-2021-47-55","article-title":"Efficacy of Netakimab in key Psoriatic arthritis domains: 54-week results from the phase III BCD-085-8\/PATERA study","volume":"59","author":"Korotaeva","year":"2021","journal-title":"Nau\u010dno-Prakti\u010deska\u00e2 Revmatologi\u00e2"},{"key":"2025090312015168000_9.3.e003279.16","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-eular.1663"},{"key":"2025090312015168000_9.3.e003279.17","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-216835"},{"key":"2025090312015168000_9.3.e003279.18","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2022-223595"},{"key":"2025090312015168000_9.3.e003279.19","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/S0140-6736(22)02303-0","article-title":"Bimekizumab in patients with active Psoriatic arthritis and previous inadequate response or intolerance to tumour necrosis factor-\u0391 inhibitors: a randomised, double-blind, placebo-controlled","volume":"401","author":"Merola","year":"2023","journal-title":"Lancet"},{"key":"2025090312015168000_9.3.e003279.20","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/S0140-6736(22)02302-9","article-title":"Bimekizumab in patients with Psoriatic arthritis, naive to biologic treatment: a randomised, double-blind, placebo-controlled","volume":"401","author":"McInnes","year":"2023","journal-title":"Lancet"},{"key":"2025090312015168000_9.3.e003279.21","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2022-eular.536"},{"key":"2025090312015168000_9.3.e003279.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.sbi.2016.10.019"},{"key":"2025090312015168000_9.3.e003279.23","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1016\/S0140-6736(21)00440-2","article-title":"Il17A\/F Nanobody Sonelokimab in patients with plaque psoriasis: a Multicentre, randomised, placebo-controlled, phase 2B study","volume":"397","author":"Papp","year":"2021","journal-title":"Lancet"},{"key":"2025090312015168000_9.3.e003279.24","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1002\/art.40759","article-title":"Ustekinumab fails to show efficacy in a phase III axial Spondyloarthritis program: the importance of negative results","volume":"71","author":"Mease","year":"2019","journal-title":"Arthritis Rheumatol"},{"key":"2025090312015168000_9.3.e003279.25","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2018-213328"},{"key":"2025090312015168000_9.3.e003279.26","doi-asserted-by":"crossref","first-page":"e715","DOI":"10.1016\/S2665-9913(21)00105-3","article-title":"Efficacy of Guselkumab on axial involvement in patients with active Psoriatic arthritis and Sacroiliitis: a post-hoc analysis of the phase 3 DISCOVER-1 and DISCOVER-2 studies","volume":"3","author":"Mease","year":"2021","journal-title":"Lancet Rheumatol"},{"key":"2025090312015168000_9.3.e003279.27","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-022-06589-y","article-title":"Efficacy and safety of Guselkumab in biologic-Na\u00efve patients with active axial Psoriatic arthritis: study protocol for STAR, a phase 4, randomized, double-blinded, placebo-controlled trial","volume":"23","author":"Gladman","year":"2022","journal-title":"Trials"},{"key":"2025090312015168000_9.3.e003279.28","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-eular.4058"},{"key":"2025090312015168000_9.3.e003279.29","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2020.01520","article-title":"GM-CSF primes proinflammatory monocyte responses in Ankylosing Spondylitis","volume":"11","author":"Shi","year":"2020","journal-title":"Front Immunol"},{"key":"2025090312015168000_9.3.e003279.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2016.10.026"},{"key":"2025090312015168000_9.3.e003279.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbrc.2008.01.023"},{"key":"2025090312015168000_9.3.e003279.32","doi-asserted-by":"publisher","DOI":"10.1586\/1744666X.2015.1024110"},{"key":"2025090312015168000_9.3.e003279.33","unstructured":"Izana Bioscience Ltd . A phase 2A study to evaluate the safety and efficacy of Namilumab in subjects with moderate-to-severely active axial Spondyloarthritis. 2022. Available: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03622658"},{"key":"2025090312015168000_9.3.e003279.34","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210724"},{"key":"2025090312015168000_9.3.e003279.35","first-page":"31","article-title":"Abatacept for the treatment of adults with Psoriatic arthritis: patient selection and perspectives","volume":"8","author":"Noisette","year":"2018","journal-title":"Psoriasis (Auckl)"},{"key":"2025090312015168000_9.3.e003279.36","unstructured":"Efficacy and safety of Neihulizumab (Abgn-168H) in patients with active Psoriatic arthritis: 24-week results from a phase II open label study. ACR meeting abstracts. n.d. Available: https:\/\/acrabstracts.org\/abstract\/efficacy-and-safety-of-neihulizumab-abgn-168h-in-patients-with-active-psoriatic-arthritis-24-week-results-from-a-phase-ii-open-label-study\/"},{"key":"2025090312015168000_9.3.e003279.37","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1007\/s11926-022-01090-6","article-title":"T cell repertoire profiling and the mechanism by which HLA-B27 causes Ankylosing Spondylitis","volume":"24","author":"Garrido-Mesa","year":"2022","journal-title":"Curr Rheumatol Rep"},{"key":"2025090312015168000_9.3.e003279.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcp.2012.01.001"},{"key":"2025090312015168000_9.3.e003279.39","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.201088"},{"key":"2025090312015168000_9.3.e003279.40","doi-asserted-by":"publisher","DOI":"10.1038\/nrd.2017.267"},{"key":"2025090312015168000_9.3.e003279.41","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1093\/rheumatology\/keab740","article-title":"A review of JAK-STAT signalling in the pathogenesis of Spondyloarthritis and the role of JAK inhibition","volume":"61","author":"McInnes","year":"2022","journal-title":"Rheumatology (Oxford)"},{"key":"2025090312015168000_9.3.e003279.42","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32463-2"},{"key":"2025090312015168000_9.3.e003279.43","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1093\/rheumatology\/kez408","article-title":"Effect of Filgotinib on health-related quality of life in active Psoriatic arthritis","volume":"59","author":"Orbai","year":"2020","journal-title":"Rheumatology"},{"key":"2025090312015168000_9.3.e003279.44","doi-asserted-by":"crossref","first-page":"3403","DOI":"10.1007\/s12325-022-02168-4","article-title":"MANTA and MANTA-ray: rationale and design of trials evaluating effects of Filgotinib on semen parameters in patients with inflammatory diseases","volume":"39","author":"Hellstrom","year":"2022","journal-title":"Adv Ther"},{"key":"2025090312015168000_9.3.e003279.45","doi-asserted-by":"publisher","DOI":"10.1021\/acs.jmedchem.9b00444"},{"key":"2025090312015168000_9.3.e003279.46","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-221664"},{"key":"2025090312015168000_9.3.e003279.47","unstructured":"Efficacy and safety of Brepocitinib (tyrosine kinase 2\/Janus kinase 1 inhibitor) for the treatment of active Psoriatic arthritis: results from a phase 2B randomized controlled trial. ACR meeting abstracts. N.d Available: https:\/\/acrabstracts.org\/abstract\/efficacy-and-safety-of-brepocitinib-tyrosine-kinase-2-janus-kinase-1-inhibitor-for-the-treatment-of-active-psoriatic-arthritis-results-from-a-phase-2b-randomized-controlled-trial\/"},{"key":"2025090312015168000_9.3.e003279.48","doi-asserted-by":"publisher","DOI":"10.1038\/nri3495"},{"key":"2025090312015168000_9.3.e003279.49","doi-asserted-by":"publisher","DOI":"10.1038\/nri1865"},{"key":"2025090312015168000_9.3.e003279.50","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-205322"},{"key":"2025090312015168000_9.3.e003279.51","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1080\/17512433.2017.1329009","article-title":"Tumor necrosis factor inhibitors in Psoriatic arthritis","volume":"10","author":"Mantravadi","year":"2017","journal-title":"Expert Rev Clin Pharmacol"},{"key":"2025090312015168000_9.3.e003279.52","doi-asserted-by":"crossref","first-page":"5373","DOI":"10.2147\/JIR.S380686","article-title":"Tyk2 in immune responses and treatment of psoriasis","volume":"15","author":"Shang","year":"2022","journal-title":"J Inflamm Res"},{"key":"2025090312015168000_9.3.e003279.53","doi-asserted-by":"publisher","DOI":"10.1038\/nri3707"},{"key":"2025090312015168000_9.3.e003279.54","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2021.614255","article-title":"Why inhibition of IL-23 lacked efficacy in Ankylosing Spondylitis","volume":"12","author":"McGonagle","year":"2021","journal-title":"Front Immunol"},{"key":"2025090312015168000_9.3.e003279.55","doi-asserted-by":"crossref","first-page":"627","DOI":"10.2147\/JEP.S262340","article-title":"Promising treatment options for axial Spondyloarthritis: an overview of experimental pharmacological agents","volume":"13","author":"Tahir","year":"2021","journal-title":"J Exp Pharmacol"},{"key":"2025090312015168000_9.3.e003279.56","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20172063"},{"key":"2025090312015168000_9.3.e003279.57","doi-asserted-by":"crossref","DOI":"10.1186\/s13075-022-02850-6","article-title":"CC-99677, a novel, oral, selective Covalent Mk2 inhibitor, Sustainably reduces pro-inflammatory cytokine production","volume":"24","author":"Gaur","year":"2022","journal-title":"Arthritis Res Ther"},{"key":"2025090312015168000_9.3.e003279.58","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1111\/bjd.21743","article-title":"Efficacy and safety of Mirikizumab in psoriasis: results from a 52-week, double-blind, placebo-controlled, randomized withdrawal, phase III trial (OASIS-1)","volume":"187","author":"Blauvelt","year":"2022","journal-title":"Br J Dermatol"},{"key":"2025090312015168000_9.3.e003279.59","first-page":"3","article-title":"Efficacy and safety of Mirikizumab as maintenance therapy in patients with moderately to severely active ulcerative colitis: results from the phase 3 LUCENT-2 study","volume":"18","year":"2022","journal-title":"Gastroenterol Hepatol (NY)"},{"key":"2025090312015168000_9.3.e003279.60","doi-asserted-by":"crossref","unstructured":"Simon D , Fagni F , Schett G . Sequential Interleukin-17\/Interleukin-23 inhibition in treatment-refractory Psoriatic arthritis. Ann Rheum Dis 2022:annrheumdis-2022-222415. doi:10.1136\/annrheumdis-2022-222415","DOI":"10.1136\/annrheumdis-2022-222415"},{"key":"2025090312015168000_9.3.e003279.61","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s10787-022-01092-x","article-title":"Psoriatic arthritis: review of potential biomarkers predicting response to TNF inhibitors","volume":"31","author":"Makos","year":"2023","journal-title":"Inflammopharmacology"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2023-003279","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T19:02:04Z","timestamp":1756926124000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2023-003279"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7]]},"references-count":61,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,7,28]]},"published-print":{"date-parts":[[2023,7]]}},"alternative-id":["10.1136\/rmdopen-2023-003279"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2023-003279","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7]]}}}