Rationale and concerns for using JAK inhibitors in axial spondyloarthritis

Abstract Axial Spondyloarthritis (AxSpA) is a chronic illness with limited treatment options. The role of Janus kinase (JAK) inhibition as a therapeutic option has increasingly become a focus of research in recent years as they have brought a new mode of action to the clinical armamentarium. This review will assess the efficacy and safety profile of these drugs in AxSpA. The current phase 2 and 3 clinical trial data will be summarized, across tofacitinib, upadacitinib and filgotinib. Moreover, the safety profiles of these drugs, in the context of emerging safety signals such as during ORAL surveillance study, will be reviewed. In summary, JAK-inhibitors offer a novel therapeutic target for AxSpA and appear to address some of the unmet needs for patients who have either failed to respond to current treatment options or in whom they are contraindicated. There is a relative lack of evidence in non-radiographic AxSpA, and longer-term trials are needed to establish true efficacy and safety profile in radiographic AxSpA.