‘Early treatment initiation’ key to drug-free remission in axial spondyloarthritis
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DESTIN, Fla. — Early treatment can provide patients with axial spondyloarthritis a better opportunity to achieve drug-free remission and slow disease progression, according to a speaker at the Congress of Clinical Rheumatology East 2022.
Specifically, Janus kinase inhibitors such as tofacitinib (Xeljanz, Pfizer), upadacitinib (Rinvoq, AbbVie) and filgotinib (Gilead Sciences/ Galapagos NV) have demonstrated capacity to reduce spine and sacroiliac joint inflammation as measured by MRIs, said Nigel Haroon, MD, PhD, DM, MBA, FRCPC, head of the rheumatology department at the University Health Network and Sinai Health, in Toronto.
In addition, although there is little X-ray evidence to support the efficacy of JAK inhibitors for patients with axial SpA, data suggest upadacitinib and tofacitinib can improve inflammation in the spine and sacroiliac joints, he said.
Meanwhile, continual NSAIDs are potentially less impactful among these patients, according to Haroon.
“The conclusion amongst the experts is that perhaps NSAIDs have a small effect, but maybe not enough to make a clinically meaningful difference, at least not in 2 years,” he said. “If patients have stable disease, then there is no need to push NSAIDs to continuous use.”
However, regardless of the therapies available, catching disease progression early is the best option for reducing progression in the patient’s future, Haroon added.
“If you’re treating these patients very, very early, and you catch the acute lesion, it can completely resolve,” he said.
According to Haroon, early intervention in patients with axial SpA allows rheumatologists to make the most of the window of opportunity for effective treatment.
“The earlier we diagnose, the earlier we can start treatment for these patients,” he said. “Early treatment initiation has a higher chance of getting a response.”
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Haroon EN. Ankylosing spondylitis: How do current and new novel therapeutic targets affect radiographic progression? Presented at: The Congress of Clinical Rheumatology East; May 12-15, 2022; Destin, Fla.
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