Harnessing AI in axSpA: The Promise of Digital Therapeutics with Axia Save

The management of axial spondyloarthritis (axSpA) continues to evolve with the integration of artificial intelligence (AI) and digital health technologies. Traditionally, treatment has centered around pharmacotherapy, physical therapy, and patient education. However, despite these advances, a substantial proportion of patients continue to experience disease activity, functional limitations, and impaired quality of life. The emergence of digital therapeutics (DTx) offers a new paradigm—combining AI-driven personalisation, remote delivery, and behavioral engagement to complement standard care. 

At #EULAR2025, the Bechterew-App Trial (LB0002) presented important new data on Axia, a novel AI-powered digital therapeutic developed for axSpA.

The Axia Platform: Personalised AI-Supported Disease Management

Axia is a comprehensive digital therapeutic platform developed in compliance with European Medical Device Regulation (MDR). It combines several key elements. These include:

• Individualised home-based exercise programs, tailored to each patient’s functional abilities and needs.
• Patient education modules, supporting disease understanding, self-management, and coping strategies.
• Comprehensive disease management tools, tracking patient progress and symptoms.
• Gamification features, designed to sustain motivation, encourage adherence, and build long-term behavioral change.

AI algorithms help customise exercise regiments, adjust intensities, and optimize interventions based on real-time patient data. Unlike generic exercise apps, Axia delivers a structured, data-driven therapeutic experience aimed directly at key clinical outcomes. 

The Bechterew-App Trial: Study Design

To rigorously test Axia’s efficacy, the research team conducted a randomised, controlled, crossover trial across Germany. Key aspects included:

• 200 axSpA patients on stable pharmacotherapy.
• Randomized 1:1 to receive either Axia or treatment as usual for 12 weeks.
• Evaluation of disease activity (BASDAI), functional status (BASFI), and quality of life (ASQoL) as primary endpoints.
• Secondary outcomes included ASAS20 and ASAS40 response rates, reflecting clinically meaningful improvements.

Key Findings: Significant Improvements Across Multiple Domains

At 12 weeks, the results were striking:

• Disease Activity (BASDAI): Axia: mean improvement –1.66 (SD 1.41) vs control: –0.11 (1.15), p<0.001.
• Functional Status (BASFI): Axia: –1.12 (1.40) vs control: +0.06 (1.31), p<0.001.
• Quality of Life (ASQoL): Axia: –2.51 (2.55) vs control: –0.16 (2.26), p<0.001.
• ASAS20 response rates: Axia group (51%)  vs control 9%, p<0.001.
• ASAS40 responses: Axia group (23%) vs control 3%, p<0.001.

No safety concerns emerged, highlighting Axia's suitability as a safe adjunct to standard care.

A Shift Toward Hybrid Care Models

These results are highly clinically relevant. For the first time, a digital therapeutic (DTx)  in rheumatology has demonstrated meaningful improvements not only in patient-reported outcomes, but also in validated disease activity indices used in daily practice.

The success of Axia illustrates several key points about digital innovation in axSpA:

• Personalisation is key: AI-driven exercise and education tailored to patient needs may enhance outcomes beyond generalised advice.
• Behavioral engagement matters: Gamification and user interaction improve adherence, which remains a major barrier in traditional home exercise programs.
• Complementary to pharmacotherapy: Axia improved outcomes even in patients who were already stable on drug treatments, suggesting an additive benefit.
• Scalable and accessible: Digital therapeutics offer scalable solutions for delivering structured care outside of the clinic setting.

The Future: AI-Enhanced Rheumatology

The Bechterew-App Trial paves the way for a growing role of AI and digital therapeutics in spondyloarthritis care. As more evidence accumulates, hybrid care models that integrate pharmacologic, physical, educational, and digital components may become the new standard.

Longer-term studies are needed to assess durability of benefit. Evaluation across broader axSpA populations, including early disease will also be needed. The Cost-effectiveness and health economics analyses as well as integration with real-world electronic health records and remote monitoring will ensure long-term sustainability. 

The Bechterew-App Trial demonstrates that AI-powered digital therapeutics like Axia can achieve meaningful improvements in disease activity, function, and quality of life for axSpA patients. These data signal an important step forward in personalised, scalable, and patient-centered care. While pharmacotherapy remains central, the future of axSpA management increasingly lies at the interface of medicine, technology, and behavioral science.