Tofacitinib for the treatment of active ankylosing spondylitis in adults

ABSTRACT

Introduction

Ankylosing spondylitis, also known as radiographic axial spondyloarthritis, is a complex, immune-mediated inflammatory disorder most commonly involving the spine including the sacroiliac joints.

Areas Covered

Complex pathogenesis of axial spondyloarthritis involving genetic, environmental, and both innate and adaptive immune systems. Treatment options for ankylosing spondylitis. Pharmacologic properties, efficacy, and safety of tofacitinib, a JAK inhibitor. Data regarding efficacy of approved JAK inhibitors in the treatment of ankylosing spondylitis, including tofacitinib, upadacitinib, and filgotinib.

Expert opinion

Current treatment options of ankylosing spondylitis include NSAIDs, TNFi, and IL-17i. JAK inhibitors present a new class of therapy that has shown efficacy in the treatment of active ankylosing spondylitis in adults. While it has not been directly compared to alternative therapies, tofacitinib has been shown to be effective in both phase II and phase III trials for the treatment of ankylosing spondylitis. While these trials did not show any significant difference from placebo in terms of safety, the ORAL Surveillance study showed tofacitinib to be inferior to TNFi when comparing adverse events. Thus, tofacitinib presents a viable treatment option for the management of AS, however shared decision-making regarding risks and benefits will be important.

KEYWORDS:

• Ankylosing spondylitis
• tofacitinib
• spondyloarthritis
• JAK-inhibitor
• JAK
• axial spondyloarthritis

Article highlights

• Ankylosing spondylitis is an immune-mediated inflammatory disorder with a complex pathogenesis involving both innate and adaptive immune systems

• There are currently many classes of medications used in the treatment of ankylosing spondylitis

• The JAK-STAT pathway plays an integral role in the pathogenesis and inflammatory cascade in axial spondyloarthritis

• JAK inhibitors are a new class of treatment options for ankylosing spondylitis

• Members of this class of medications include tofacitinib, upadacitinib, baricitinib, and filgotinib

• Tofacitinib provides a new treatment option for patients with ankylosing spondylitis, though an informed discussion with regard to risks and benefits is important prior to initiation

Declaration of Interest

A Deodhar declares consulting and advisory boards for AbbVie, Amgen, Aurinia, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Glaxo Smith & Kline, Janssen, Moonlake, Novartis, Pfizer, UCB. A Deodhar also declares research grants from AbbVie, Eli Lilly, Glaxo Smith & Kline, Novartis, Pfizer, UCB. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.