Tofacitinib for the Treatment of Active Ankylosing Spondylitis in Adults - Recent Insights

Ankylosing spondylitis, also called spine osteoarthritis, radiographic axial spondyloarthritis is a form of arthritis which is autoimmune in nature and leads to chronic spine inflammation including inflammation of the sacroiliac joint (situated in between the base of the vertebrae and the pelvis) leading to permanent disability in which patient will find difficulty in walking as well as breathing (as rib cage expands during breathing) and doing daily activities. Currently non-steroidal anti-inflammatory drugs (NSAIDs) and biological agents, including TNFα inhibitors and IL-17 inhibitors are considering as the treatment options. Despite the fact that these medications are available, many patients either do not respond well, slowly lose their initial therapeutic response, or experience unfavourable side effects, underscoring the need for alternative treatment approaches. Tofacitinib which is a janus kinase inhibitor, have more axial penetration than other FDA approved drugs for ankylosing spondylitis. As a result, it is crucial in blocking the process of intracellular signalling from the receptor to the cellular nucleus and blocks the inflammatory response through a novel pathway. In this review, we discuss the role of tofacitinib in axial spondyloarthritis (axSpA) and present the findings of current clinical trials of JAKi (tofacitinib, Upadacitinib, and filgotinib) in axSpA patients.