New pharmacologic treatment options for ankylosing spondylitis-JAK inhibitors

Abstract Aims: This review aims to present the current knowledge on the efficacy and safety of a new therapeutic option approved for the treatment of ankylosing spondylitis - JAK inhibitors: upadacitinib and tofacitinib. These therapies may benefit patients with an inadequate response to or intolerance of NSAIDs or bDMARDs. Material and methods: A systematic search of PubMed was conducted, focusing on the past ten years and selected studies from key years. The search strategy included relevant keywords related to Janus kinase (JAK) inhibitors, ankylosing spondylitis (AS), upadacitinib, and tofacitinib. The most pertinent articles aligned with the study objective were reviewed and included. Results: Seventeen publications were included in the review, comprising ten clinical studies and seven secondary analyses or review articles. Clinical studies demonstrated improvement in ASAS40, ASDAS, BASFI, and BASDAI50 scores, reduced spinal and sacroiliac inflammation, and improved quality of life in patients with AS treated with tofacitinib or upadacitinib. The most frequently reported adverse events were mild to moderate in severity. No new adverse events were observed beyond those already known and consistent with the established safety profile of JAK inhibitors. Post hoc analyses and review papers confirmed the findings of clinical studies and provided additional insights into selected patient subgroups. Conclusions: Tofacitinib and upadacitinib are effective and reasonably safe for AS, including patients who do not respond to or tolerate NSAIDs or bDMARDs. They offer a favorable benefit–risk balance and are viable options after first-line failure, though more long-term data are needed.