Publications

Van den Bosch et al. reported that upadacitinib 15 mg once daily led to sustained improvement in nr-axSpA over two years, including disease activity, pain, and quality of life. The study reports that 57.1% achieved ASAS40 response at week 104, with no new safety signals identified.

Baraliakos et al. evaluated the long-term safety and efficacy of bimekizumab in axSpA through a 2-year analysis of the BE MOBILE 1 and BE MOBILE 2 studies. Bimekizumab was well tolerated, with a consistent safety profile and no new safety signals. Clinical improvements, including ASAS40 response and MRI remission, were sustained through Wk104.

The 1-year results of the SELECT-AXIS 2 study showed significant improvements in ASAS40 achievement in patients with nr-axSpA that were treated with upadacitinib 15mg QD versus placebo. Improvements in ASDAS endpoints, back pain, BASFI, and hsCRP from baseline were also observed.

The 5-year benefit-risk profile for upadacitinib in RA remains favourable, with clinical outcomes improved or maintained through Week 260. No new safety findings were identified during the LTE. Results remained consistent with earlier analyses of SELECT-NEXT.

The 2023 EULAR recommendations provided an updated consensus on the pharmacological management of PsA with a new overarching principle and recommendation for 2023. Recent MOA safety data emphasised the importance of patient-specific benefit-risk profiling in JAKi therapy, and extra-musculoskeletal (MSK) manifestations related to PsA should be considered during drug selection.

Fleischmann, et al. found that patients who switched from adalimumab to upadacitinib and vice versa following lack of improvement showed improvements in disease activity measures and functional outcomes through 228 weeks.

Data from this open-label extension showed the efficacy of upadacitinib observed at 56 weeks was maintained through to 152 weeks in the treatment of patients with PsA. No cumulative adverse effects were observed, and no new safety signals were identified.

Braun et al. studied a large cohort of patients with nr-axSpA, that demonstrated a secukinumab reduced SI joint inflammation (BME), this reduction was sustained over 104 weeks, from an overall low baseline level of spinal inflammation or structural damage.

Bimekizumab may therefore offer patients with axSpA an effective treatment option with a novel mode of action.

Since the last update in 2016, more data have become available on existing treatment options for axSpA, and particularly on IL-17i. The increasing availability of more drugs and with different modes of action raises questions around their positioning in the treatment pathway. This review sought to update the 2016 recommendations with newly available evidence.