Klavdianou Kalliopi, Papagoras Charalampos, Baraliakos Xenofon
Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Germany.
Department of Rheumatology, 'Asklepieion' General Hospital, Athens, Greece.
Mediterr J Rheumatol. 2023 Jun 30;34(2):129-138. doi: 10.31138/mjr.34.2.129. eCollection 2023 Jun.
Axial spondyloarthritis (axSpA) is a chronic disease characterized by inflammation and new bone formation that causes pain and results in functional impairment and long-term disability. Biologic agents targeting TNFα or IL-17 have been the mainstay of treatment for patients with axSpA and an inadequate response to nonsteroidal anti-inflammatory drugs. However, a proportion of axSpA patients do not respond adequately to those drugs either, creating the need to target alternative disease pathways. Janus kinase (JAK) inhibitors (JAKis) are a group of targeted synthetic disease-modifying anti-rheumatic drugs that block the intracellular signalling pathway of several proinflammatory cytokines. Given their efficacy in the management of rheumatoid arthritis and that JAKs mediate the signalling of cytokines involved in the pathogenesis of axSpA as well, JAKis have been successfully tested in a number of clinical trials in axSpA, which has led to the approval of two compounds, tofacitinib and upadacitinib for the treatment of the disease. Data from new clinical trials, long-term extensions of completed trials, and real-life observational studies that continuously emerge will shape the efficacy and safety profile and ultimately the place of JAKis in the treatment of AxSpA.
中轴型脊柱关节炎（axSpA）是一种慢性疾病，其特征为炎症和新骨形成，可导致疼痛，并造成功能障碍和长期残疾。针对肿瘤坏死因子α（TNFα）或白细胞介素-17（IL-17）的生物制剂一直是axSpA患者且对非甾体抗炎药反应不佳时的主要治疗手段。然而，一部分axSpA患者对这些药物也没有充分反应，因此需要针对其他疾病途径进行治疗。Janus激酶（JAK）抑制剂（JAKis）是一类靶向合成的改善病情抗风湿药，可阻断多种促炎细胞因子的细胞内信号通路。鉴于其在类风湿关节炎治疗中的疗效，且JAK介导了与axSpA发病机制相关的细胞因子信号传导，JAKis已在多项axSpA临床试验中成功进行了测试，这导致两种化合物托法替布和乌帕替尼获批用于该疾病的治疗。来自新临床试验、已完成试验的长期扩展研究以及不断涌现的真实世界观察性研究的数据，将塑造JAKis的疗效和安全性概况，并最终确定其在axSpA治疗中的地位。
