The past three decades have witnessed remarkable advances in our ability to 
target specific elements of the immune and inflammatory response, fuelled by 
advances in both biotechnology and disease knowledge. As well as providing 
superior treatments for immune-mediated inflammatory diseases (IMIDs), such 
therapies also offer unrivalled opportunities to study the underlying 
immunopathological basis of these conditions.In this review, we explore recent 
approaches to the treatment of IMIDs and the insights to pathobiology that they 
provide. We review novel biologic agents targeting the T-helper 17 axis, 
including therapies directed towards interleukin (IL)-17 (secukinumab, 
ixekizumab, bimekizumab), IL-17R (brodalumab), IL-12/23p40 (ustekinumab, 
briakinumab) and IL-23p19 (guselkumab, tildrakizumab, brazikumab, risankizumab, 
mirikizumab). We also present an overview of biologics active against type I and 
II interferons, including sifalumumab, rontalizumab, anifrolumab and 
fontolizumab. Emerging strategies to interfere with cellular adhesion processes 
involved in lymphocyte recruitment are discussed, including both integrin 
blockade (natalizumab, vedolizumab, etrolizumab) and sphingosine-1-phosphate 
receptor inhibition (fingolimod, ozanimod). We summarise the development and 
recent application of Janus kinase (JAK) inhibitors in the treatment of IMIDs, 
including first-generation pan-JAK inhibitors (tofacitinib, baricitinib, 
ruxolitinib, peficitinib) and second-generation selective JAK inhibitors 
(decernotinib, filgotinib, upadacitinib). New biologics targeting B-cells 
(including ocrelizumab, veltuzumab, tabalumab and atacicept) and the development 
of novel strategies for regulatory T-cell modulation (including low-dose IL-2 
therapy and Tregitopes) are also discussed. Finally, we explore recent 
biotechnological advances such as the development of bispecific antibodies 
(ABT-122, COVA322), and their application to the treatment of IMIDs.