tofacitinib for treating active ankylosing spondylitis

Last edited 10/2023 and last reviewed 10/2023

Tofacitinib is an oral Janus kinase (JAK) inhibitor (1):

• JAK inhibitors directly bind to and modulate the intracellular catalytic activity of JAKs, which are essential enzymes in signalling pathways that mediate cytokine signalling for many innate and adaptive immune responses underlying the complex pathogenesis of ankylosing spondylitis
  • activation of these signalling pathways ultimately leads to the proliferation of inflammatory cells in articular and extramusculoskeletal locations, and of cell types associated with the hallmarks of ankylosing spondylitis such as joint destruction

NICE state:

• Tofacitinib is recommended as an option for treating active ankylosing spondylitis that is not controlled well enough with conventional therapy in adults, only if:
  • tumour necrosis factor (TNF)-alpha inhibitors are not suitable or do not control the condition well enough and
  • the company provides tofacitinib according to the commercial agreement
• asssess response to tofacitinib after 16 weeks of treatment. Continue treatment only if there is clear evidence of response, defined as:
  • a reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score to 50% of the pre-treatment value or by 2 or more units and
  • a reduction in the spinal pain visual analogue scale (VAS) by 2 cm or more

Reference:

• Deodhar A, Sliwinska-Stanczyk P, Xu H, Baraliakos X, Gensler LS, Fleishaker D, Wang L, Wu J, Menon S, Wang C, Dina O, Fallon L, Kanik KS, van der Heijde D. Tofacitinib for the treatment of ankylosing spondylitis: a phase III, randomised, double-blind, placebo-controlled study. Ann Rheum Dis. 2021 Aug;80(8):1004-1013.
• NICE (October 2023). Tofacitinib for treating active ankylosing spondylitis