In the last ten years, TNF-α inhibitors have transformed the treatment of axial spondyloarthritis, including ankylosing spondylitis and nonradiographic axial spondyloarthritis, and have brought new attention to this enigmatic autoimmune disease. Today, a second wave of biological therapies is being approved for this indication, the success of which will be shaped by the remaining unmet needs within this population. This report examines areas of unmet need in axial spondyloarthritis, including radiographic progression, short-term efficacy, safety and tolerability, delivery, and the availability of therapies for patients without signs of radiographic damage.


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