by Drs. David Borenstein M.D. and C.H. Weaver M.D. 12/2018
Many individuals with ankylosing spondylitis (AS) still don't experience optimal treatment and relief of symptoms with currently available therapies and researchers continue to try to develop more effective treatments.
A new class of medications called Janus kinase inhibitors (JAK) appear promising and should represent a new treatment option for individuals with AS. Both upadacitinib and filgotinib are close to FDA approval and should become available in 2019. Filgotinib has selectivity for subtype JAK 1 and is considered promising because it inhibits JAK1 selectively. Less selective JAK inhibitors like Xeljanz (tofacitinib) are already successfully used for the treatment of inflammatory conditions and have demonstrated long term effectiveness. Their lack of selectivity however leads to some dose-limiting side effects and selective JAK 1 inhibitors are being developed to avoid these complications.
About the TORTUGA Study
The results of the recently published TORTUGA clinical trial suggest filgotinib represents a new and effective treatment option for AS.
The TORTUGA clinical trial assessed the safety and effectiveness of filgotinib in adult patients with moderately to severely active AS. A total of 116 patients were treated with filgotinib 200 mg or a placebo (sugar pill) once daily for 12 weeks and directly compared. The filgotinib treated patients experienced a significant improvement in disease activity and the medication was generally well tolerated.
Filgotinib and upadacitinib are not currently available but should become so in 2019 and patients seeking new treatment options should watch for their approval.