Ankylosing spondylitis (AS) and axial spondyloarthritis (ax SpA) are chronic 
inflammatory diseases mainly involving the axial skeleton. Pharmacological 
treatments for AS and ax SpA usually include local glucocorticoid injections, 
NSAIDs and anti-TNFα agents. Since around 30% to 40% of patients are non 
responders or intolerant to anti-TNFα agents, we need new therapeutic options 
for AS and ax SpA. Areas covered: This review describes the new biological 
agents that can be used or are in development for AS or ax SpA as well as 
emerging synthetic targeted drugs. Expert opinion: Based on the rationale of the 
involvement of the IL-23/Th17 axis in AS, novel biological agents have been 
developed and include secukinumab, an anti-IL-17A agent and ustekinumab, an 
anti-IL-23 antibody. New compounds in the class of synthetic drugs are 
apremilast, a PDE4 inhibitor, and inhibitors of kinase pathways. Secukinumab 
gave positive results in the treatment of AS. Ustekinumab yielded promising 
results in AS in an open labeled study. Apremilast is not effective in AS while 
results with kinase inhibitors are preliminary. Future studies will clarify the 
place of secukinumab in the therapeutic management of AS, its influence on 
radiographic progression and its effects on the non radiographic form of the 
disease.