Janus kinase inhibitors were recently approved for treatment of axial spondyloarthritis following clinical trials demonstrating benefit for symptom control. Upadacitinib treatment resulted in Assessment of SpondyloArthritis International Society 40 response improvement (defined as at least 40% improvement and an absolute improvement in global assessment of disease activity, patient assessment of back pain and other indices) in 45-52% of trial participants with axial spondyloarthritis. We review the data for efficacy and safety of upadacitinib in this patient population.
Keywords: Janus kinase inhibitor; ankylosing spondylitis; axial spondyloarthritis; psoriatic arthritis; upadacitinib.
This review article evaluates the effectiveness and safety of an oral (pill) medication called upadacitinib in treating a condition called axial spondyloarthritis, an inflammatory arthritis that affects the spine as well as other joints. Upadacitinib is a type of medication known as a Janus kinase inhibitor (JAKib) and is the newest approved medication for axial spondyloarthritis. The treatment of axial spondyloarthritis typically involves exercise and the use of NSAIDs and other biologic, injectable medications called TNF inhibitors and IL-17 inhibitors. However, not all patients respond well to these treatments. JAKibs, including upadacitinib, have been approved for other conditions like rheumatoid arthritis and psoriatic arthritis. They work by blocking certain signals in the body that contribute to inflammation. However, JAKibs have been associated with certain risks, such as an increased risk of infections, cardiovascular events and thrombotic events (blood clots). We summarize the findings of several clinical trials that evaluated the effectiveness of upadacitinib in treating people with axial spondyloarthritis. In these trials, upadacitinib showed greater efficacy (performed better) compared with a placebo. The trials also showed that upadacitinib had a similar safety profile (few infections, cardiovascular and thrombotic events) to previous trials conducted in rheumatoid arthritis and psoriatic arthritis. However, more research is needed to fully understand the long-term safety and effectiveness of upadacitinib in treating these conditions. Overall, upadacitinib is a promising treatment option for people with axial spondyloarthritis who have not responded well to other medications.