upadacitinib in ankylosing spondylitis

Last edited 10/2022 and last reviewed 10/2022

Upadacitinib in ankylosing spondylitis

Upadacitinib, an oral JAK (Janus Kinase) inhibitor

• engineered for increased selectivity for JAK1 over JAK2, JAK3, and tyrosine kinase 2
• used in the management of ankylosing spondylitis

NICE state:

• upadacitinib 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 upadacitinib according to the commercial agreement
• if patients and their clinicians consider upadacitinib to be one of a range of suitable treatments (including secukinumab and ixekizumab), choose the least expensive treatment, taking into account administration costs, dosage, price per dose and commercial arrangements
• assess response to upadacitinib 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
• take into account any physical, sensory or learning disabilities, or communication difficulties that could affect the responses to the BASDAI and spinal pain VAS and make any adjustments needed

Reference:

• NICE (September 2022). Upadacitinib for treating active ankylosing spondylitis.