Efficacy of Tofacitinib in the Treatment of Axial Spondyloarthritis
Efficacy of Tofacitinib
DOI:
https://doi.org/10.54393/pjhs.v4i12.1215Keywords:
Axial Spondyloarthritis, Tofacitinib, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)Abstract
Tofacitinib is a janus kinase enzyme inhibitor used in the treatment several inflammatory conditions. It orchestrates cytokine communication for numerous natural and adaptive immunological responses and underlie the intricate pathophysiology of AS, are directly bound by JAK inhibitors and their intracellular catalytic activity is controlled. For the medical care of older individuals with axial spondyloarthritis, tofacitinib, an oral JAK inhibitor, is being studied. Objective: To analyze the efficacy of tofacitinib in the treatment of axial spondylarthritis in adult patients. Methods: During the time frame of 1st November 2022 till 31st October 2023 at the department of rheumatology, Lady Reading Hospital, Peshawar, patients with active axial spondyloarthritis who fulfilled the modified New York criteria and who were refractory to NSAIDs were registered in this study. Patients were randomized to receive tofacitinib 5mg x BID for 12 weeks, or a placebo, in equal groups (A and B). The study's major end goal was the evaluation of Spondyloarthritis International Society responses evaluating a 20% improvement (ASAS20) at week 12. Results: 44 patients were enrolled (22 in each group). The mean age of tofacitinib arm was 41.19 ± 5.075 years versus 39.83 ± 4.989 years in placebo group. Tofacitinib was effective in 17 patients (77.3%) as compared to 07 patients (31.8%) in placebo group. Treatment response was significant higher (p = 0.002) with tofacitinib. Conclusions: Tofacitinib considerably out-performed a placebo when used to treat people with active axial spondyloarthritis.
References
Boel A, Molto A, van der Heijde D, Ciurea A, Dougados M, Gensler LS, et al. Do patients with axial spondyloarthritis with radiographic sacroiliitis fulfil both the modified New York criteria and the ASAS axial spondyloarthritis criteria? Results from eight cohorts. Annals of the Rheumatic Diseases. 2019 Nov; 78(11): 1545-1549. doi: 10.1136/annrheumdis-2019-215707. DOI: https://doi.org/10.1136/annrheumdis-2019-215707
Dean LE, Jones GT, MacDonald AG, Downham C, Sturrock RD, Macfarlane GJ. Global prevalence of ankylosing spondylitis. Rheumatology. 2014 Apr; 53(4): 650-7. doi: 10.1093/rheumatology/ket387. DOI: https://doi.org/10.1093/rheumatology/ket387
Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A. Ankylosing spondylitis: an overview. Annals of the Rheumatic Diseases. 2002 Dec; 61(3): iii8-18. doi: 10.1136/ard.61.suppl_3.iii8. DOI: https://doi.org/10.1136/ard.61.suppl_3.iii8
Poddubnyy D, Sieper J. Treatment of Axial Spondyloarthritis: What Does the Future Hold? Current Rheumatology Reports. 2020 Jul; 22(9): 47. doi: 10.1007/s11926-020-00924-5. DOI: https://doi.org/10.1007/s11926-020-00924-5
Bohn R, Cooney M, Deodhar A, Curtis JR, Golembesky A. Incidence and prevalence of axial spondyloarthritis: methodologic challenges and gaps in the literature. Clinical and Experimental Rheumatology. 2018 Jan; 36(2): 263-274.
van der Heijde D, Ramiro S, Landewé R, Baraliakos X, Van den Bosch F, Sepriano A, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Annals of the Rheumatic Diseases. 2017 Jun; 76(6): 978-991. doi: 10.1136/annrheumdis-2016-210770. DOI: https://doi.org/10.1136/annrheumdis-2016-210770
Ward MM, Deodhar A, Gensler LS, Dubreuil M, Yu D, Khan MA, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Care and Research. 2019 Oct; 71(10): 1285-1299. doi: 10.1002/acr.24025. DOI: https://doi.org/10.1002/acr.24025
Hodge JA, Kawabata TT, Krishnaswami S, Clark JD, Telliez JB, Dowty ME, et al. The mechanism of action of tofacitinib - an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis. Clinical and Experimental Rheumatology. 2016 Mar; 34(2): 318-28.
Veale DJ, McGonagle D, McInnes IB, Krueger JG, Ritchlin CT, Elewaut D, et al. The rationale for Janus kinase inhibitors for the treatment of spondyloarthritis. Rheumatology. 2019 Feb; 58(2): 197-205. doi: 10.1093/rheumatology/key070. DOI: https://doi.org/10.1093/rheumatology/key070
Burmester GR, Blanco R, Charles-Schoeman C, Wollenhaupt J, Zerbini C, Benda B, et al. Tofacitinib (CP-690,550) in combination with methotrexate in patients with active rheumatoid arthritis with an inadequate response to tumour necrosis factor inhibitors: a randomised phase 3 trial. Lancet. 2013 Feb; 381(9865): 451-60. doi: 10.1016/S0140-6736(12)61424-X. DOI: https://doi.org/10.1016/S0140-6736(12)61424-X
Fleischmann R, Kremer J, Cush J, Schulze-Koops H, Connell CA, Bradley JD, et al. Placebo-controlled trial of tofacitinib monotherapy in rheumatoid arthritis. New England Journal of Medicine. 2012 Aug; 367(6): 495-507. doi: 10.1056/NEJMoa1109071. DOI: https://doi.org/10.1056/NEJMoa1109071
Deodhar A, Sliwinska-Stanczyk P, Xu H. Tofacitinib for the treatment of ankylosing spondylitis: a phase III, randomised, double-blind, placebo-controlled study. Annals of the Rheumatic Diseases. 2021 Jan; 80: 1004-1013. doi: 10.1136/annrheumdis-2020-219601. DOI: https://doi.org/10.1136/annrheumdis-2020-219601
Mease P, Hall S, FitzGerald O, van der Heijde D, Merola JF, Avila-Zapata F, et al. Tofacitinib or Adalimumab versus Placebo for Psoriatic Arthritis. New England Journal of Medicine. 2017 Oct; 377(16): 1537-1550. doi: 10.1056/NEJMoa1615975. DOI: https://doi.org/10.1056/NEJMoa1615975
Gladman D, Rigby W, Azevedo VF, Behrens F, Blanco R, Kaszuba A, et al. Tofacitinib for Psoriatic Arthritis in Patients with an Inadequate Response to TNF Inhibitors. New England Journal of Medicine. 2017 Oct; 377(16): 1525-1536. doi: 10.1056/NEJMoa1615977. DOI: https://doi.org/10.1056/NEJMoa1615977
Sandborn WJ, Ghosh S, Panes J, Vranic I, Su C, Rousell S, et al. Tofacitinib, an oral Janus kinase inhibitor, in active ulcerative colitis. New England Journal of Medicine. 2012 Aug; 367(7): 616-24. doi: 10.1056/NEJMoa1112168. DOI: https://doi.org/10.1056/NEJMoa1112168
Alinaghi F, Calov M, Kristensen LE, Gladman DD, Coates LC, Jullien D, et al. Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies. Journal of the American Academy of Dermatology. 2019 Jan; 80(1): 251-265.e19. doi: 10.1016/j.jaad.2018.06.027. DOI: https://doi.org/10.1016/j.jaad.2018.06.027
Prey S, Paul C, Bronsard V, Puzenat E, Gourraud PA, Aractingi S, et al. Assessment of risk of psoriatic arthritis in patients with plaque psoriasis: a systematic review of the literature. Journal of the European Academy of Dermatology and Venereology. 2010 Apr; 24(2): 31-5. doi: 10.1111/j.1468-3083.2009.03565.x. DOI: https://doi.org/10.1111/j.1468-3083.2009.03565.x
Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis and Rheumatology. 2006 Aug; 54(8): 2665-73. doi: 10.1002/art.21972. DOI: https://doi.org/10.1002/art.21972
Jadon DR, Sengupta R, Nightingale A, Lindsay M, Korendowych E, Robinson G, et al. Axial Disease in Psoriatic Arthritis study: defining the clinical and radiographic phenotype of psoriatic spondyloarthritis. Annals of the Rheumatic Diseases. 2017 Apr; 76(4): 701-707. doi: 10.1136/annrheumdis-2016-209853. DOI: https://doi.org/10.1136/annrheumdis-2016-209853
Chandran V. Psoriatic spondylitis or ankylosing spondylitis with psoriasis: same or different? Current Opinions in Rheumatology. 2019 Jul; 31(4): 329-334. doi: 10.1097/BOR.0000000000000609. DOI: https://doi.org/10.1097/BOR.0000000000000609
Feld J, Chandran V, Haroon N, Inman R, Gladman D. Axial disease in psoriatic arthritis and ankylosing spondylitis: a critical comparison. Nature Reviews Rheumatology. 2018 Jun; 14(6): 363-371. doi: 10.1038/s41584-018-0006-8. DOI: https://doi.org/10.1038/s41584-018-0006-8
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Pakistan Journal of Health Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments
