Axial spondyloarthritis (axSpA) is a frequent condition, affecting almost 2% of the population. One of the key therapeutic agents for axSpA are the TNF inhibitors, which have been shown to significantly improve multiple aspects of axSpA and consequently, these medications are being utilised in an increasing percentage of patients. Understanding the factors affecting the retention rates of the TNF inhibitors is a key aspect of management as it describes the overall benefit of the treatment, including efficacy and adverse reactions. We hereby describe a number of factors influencing the retention of TNF inhibitors in axSpA, with confirmation of several previously described factors such as sex and patient / doctor discordance, we bring additional data to the long-standing debate regarding the role for conventional synthetic DMARD therapy in combination with the TNF inhibitor and we explore the differences across countries with data from the EuroSpA collaboration of axSpA registries.