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JAKi for nonradiographic axSpA

Robert Chao, MD Jun 01, 2022

One area of continued interest for many rheumatologists is the field of non-radiographic axial spondyloarthritis. Furthermore, the question of the utility of JAK inhibitors for the treatment of axial spondyloarthritis has been on the rise.

Hamroun @annamolto et al. Factors assoc with increased time to conception in SpA. 56 pregnancies. Multivariate model, age (HR 1.22 (1.08-1.40)) and preconception NSAID use (HR 3.01 (2.15-3.85)) assoc increase time to conception. @RheumNow #EULAR2022 OP0153 https://t.co/y2EAyAdRmk https://t.co/28aLimRInE

EULAR Abstract Archive

The PROOF study showed the predictors of radiographic progression included male gender HR 3.16, good response to NSAIDs HR 4.66, fulfillment of the imaging arm HR 6.64 and HLA-B27+ HR 3.99 by Poddubnyy et al #EULAR2022 @RheumNow OP0149

The GESPIC cohort reports in Axial PsA, 75% had inflammatory back pain, 45% met NY criteria for AS, 55% with active inflammatory change in SI joint and 60% in the spine. This is where the overlap between Axial PsA and Axial SpA happens, Kading et al #EULAR2022 @RheumNow OP0026

Pregnancy outcomes in SpA Increased risk of ❗️gestational diabetes aRR 1.88 ❗️Cesarean delivery aRR 1.54 & 1.23 ❗️preterm birth aRR 1.52 ❗️trend for increased infection in 1st year of life in newborns aRR 1.23. #EULAR2022 @RheumNow OP0126 https://t.co/jMryB5UXQr

Hamroun S et al for the GR2 Cohort showed that age HR 1.22 and use of NSAIDs HR 3.01 in the pre-conception period was associated with a longer time to conception in women with SpA. Research is needed on continuous NSAID use in the preconception period #EULAR2022 @RheumNow OP0153 https://t.co/hl6jUlK5PN

How many and quickly does nr-AxSpA progress to r-AxSpA? Poddubnyy et al for the PROOF study showed that 16% of nr-AxSpA pts progressed to r-AxSpA within 5 years, mean time to radiographic progression was 2.4 years #EULAR2022 @RheumNow OP0149 https://t.co/KTC8Xkt4ey

Good morning from Copenhagen. Starting the day with looking at imaging in SpA, review of posters, vaccination, lupus nephritis and auto inflammatory disease #EULAR2022 @RheumNow https://t.co/aPEkLjDaK7

ASRI @Gillianfitzger1 @bososhea @Sineadm15 Current smoking is associated with lower risk of uveitis and arthritis in males with axSpA. I wonder why this would be? @RheumNow #EULAR2022 POS1001 https://t.co/3bKmyvI606

Sex differences may affect the response to first line TNFi in AxSpA. Hellamund et al EuroSpA study showed the TNFi 6/12/24 month retention rate was lower in females (58%) compared to males (72%). Females had lower CRP level and higher PROs at baseline #EULAR2022 @RheumNow OP0020 https://t.co/ANgRYMxpat

Upadacitinib shows promising response in the treatment of nr-AxSpA in the SELECT-AXIS 2 study. Deodhar et al showed the ASAS40 response rate for UPA was twice vs placebo (45% vs 23%). 12/14 of the secondary endpoints were also met #EULAR2022 @RheumNow OP0016 https://t.co/dOWVJdLRtG

Updated #EULAR2022 AxSpa Recc: The Algorithm @rheumnow https://t.co/fu46QJ3jmQ

GR2 cohort prospective study of pregnancies in 126 pts w/ SpA over 15 years -Rx exposure 23% steroids, 11% NSAIDS, 55% biologics - 116 live births, 7 miscarriages, 3 stillbirths - 36.5% had unfavorable pregnancy outcomes - 19% SGA - 4.8% preterm birth #EULAR2022 @rheumnow POS1000

SELECT-AXIS 2: RCT UPA 15 mgQD vs. PBO in NRAxSpA as expected: ↘️disease activity ↘️pain and function ↘️QoL at 14 wks no new safety alerts https://t.co/2efpx7Mi6i

AxSpA and AxPsA 2 sides of the same coin or 2 different diseases? Divergent IL-23i efficacy data seem to suggest the latest. German GESPIC AxPsA cohort: *More frequently 🚺 *Less frequently B27+ *20% isolated Ax involvement @Rheumnow OP0026 #EULAR2022 https://t.co/FZP9nEyG7J

Phase 3 RCT upadacitinib in nrAxSpA. Clinical (ASAS40), PRO, and radiologic response seen at week 14 vs placebo @RheumNow #EULAR2022 OP0016 https://t.co/s3Vf4QiiAD https://t.co/gzlxZ3sxHF

EULAR Abstract Archive

#EULAR2022 OP0073: Gender-specific assessment for MRI imaging criteria ⭐️Sex differences in axSpA - disease presentations, jt biomechanics, diagnostic delay in ♀️ ⭐️Higher fat metaplasia in ♂️, Sclerosis in ♀️ ⭐️Ankylosis much higher in ♂️ (DOR 40!) @Rheumnow

Hellamand et al. Sex differences in first TNFi response in AxSpA. Treatment efficacy (RR 0.85) and retention (58% vs 72% month 24) rates lower in females. @RheumNow #EULAR2022 OP0020 https://t.co/2IL88K7q40 https://t.co/hSJds5EJFK

EULAR Abstract Archive

Bimekizumab (dual 17A/17F inhibitor) RCT in AS. ASAS40 45% vs 23% at week 16. All secondary clinical and imaging endpoints also + @RheumNow #EULAR2022 OP0019 https://t.co/RiZ7Divap3 https://t.co/ushogL5TaX

EULAR Abstract Archive

Dr Fabian Proft @ProftDr present CONSUL open label RCT of effect of adding NSAIDS to TNFi on structural outcomes. Bottom line, no significant difference in mSASSS. However new syndesmophytes in 11% vs 25%. @RheumNow #EULAR2022 OP0018 https://t.co/OcYH6oKbJQ https://t.co/kxH5vUdibe

EULAR Abstract Archive

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JAKi for nonradiographic axSpA

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