Drug Evaluation

Internal Medicine Residency Program, Boston University Medical Center, Boston, MA 02118, USA

https://orcid.org/0000-0002-8104-2450

Section of Rheumatology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA

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Maureen Dubreuil

*Author for correspondence:

E-mail Address: mdubreui@bu.edu

https://orcid.org/0000-0002-6253-1515

Section of Rheumatology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA

VA Boston Healthcare System, Boston, MA 02130, USA

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Published Online:7 Sep 2023https://doi.org/10.2217/imt-2023-0032

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Abstract

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.

Plain language summary

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.

Tweetable abstract

Review the evidence behind upadacitinib, the newest Janus kinase inhibitor approved for treatment of spondyloarthritis.

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Papers of special note have been highlighted as: •• of considerable interest

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Vol. 15, No. 15

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History

Received 8 February 2023

Accepted 10 August 2023

Published online 7 September 2023

Published in print October 2023

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Financial & competing interests disclosure

N George and JW Liew have no competing interests to declare. M Dubreuil served on an advisory board for UCB Inc., and received an investigator-initiated research grant from Pfizer. JW Liew was supported by the Spondyloarthritis Research and Treatment Network seed grant, the Spondylitis Association of America Bruckel Award and the Rheumatology Research Foundation Investigator Award. M Dubreuil was supported by the Spondylitis Association of America Bruckel Award, and the Rheumatology Research Foundation R Bridge Award. 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.

No writing assistance was utilized in the production of this manuscript.

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The role of upadacitinib for the treatment of axial spondyloarthritis

Abstract

Plain language summary

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References