Award Title: Upadacitinib for treating active non-radiographic axial spondyloarthritis [ID3958]
Funder: Department of Health and Social Care

Abstract: Axial spondyloarthritis belongs to a clinically heterogeneous group of inflammatory rheumatologic diseases which share common genetic, histological and clinical features (also including psoriatic arthritis, arthritis associated with inflammatory bowel disease, reactive arthritis and undifferentiated spondylarthritis). Axial spondyloarthritis involves inflammation of the sacroiliac joints and spine. If inflammation is visible on x-ray (as erosions, thickening of the bone, or fusion of joints), the disease is classified as radiographic axial spondyloarthritis (also known as ankylosing spondylitis). If x-rays of the sacroiliac joints and spine are normal, but there are other objective signs of inflammation (elevated C-reactive protein or evidence on magnetic resonance imaging) the disease is classified as nonradiographic axial spondyloarthritis. _x000D_
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The clinical symptoms of axial spondyloarthritis can vary from person to person, but usually develop slowly over several months or years. The main symptoms can include back pain, which will be inflammatory in nature, peripheral arthritis (inflammation in the joints in other parts of the body), enthesitis (inflammation where a bone is joined to a tendon), and fatigue. Extra-articular manifestations include uveitis, inflammatory bowel disease and psoriasis. The average age of onset of symptoms is 24 years, with an average of 8.5 years before a diagnosis is made, by which time damage to the spine which can be irreversible may have occurred. [1] _x000D_
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Around 220,000 adults have been diagnosed as having axial spondyloarthritis and an estimated 1 in 200 of the adult population in the UK is affected. [1] Non-radiographic axial spondyloarthritis affects approximately equal numbers of men and women, but there are limited data on the prevalence of the condition. _x000D_
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Conventional therapy for non-radiographic axial spondyloarthritis includes antiinflammatory treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy. NICE technology appraisal guidance 383 and 497 recommend tumour necrosis factor-alpha inhibitors adalimumab, certolizumab pegol, etanercept and golimumab as treatment options in people with disease that does not respond adequately to or cannot tolerate NSAIDs. Biosimilar versions of adalimumab, etanercept and golimumab are now available. _x000D_
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NICE technology appraisals 719 and 718 recommend secukinumab and ixekizumab as options for treating active non-radiographic axial spondyloarthritis with objective signs of inflammation (shown by elevated C-reactive protein or MRI) that is not controlled well enough with non-steroidal anti-inflammatory drugs (NSAIDs) only if tumour necrosis factor (TNF)-alpha inhibitors are not suitable or do not control the condition well enough._x000D_
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References_x000D_
1 National Axial Spondyloarthritis Society. What are the issues in axial SpA (AS)? Available from: https:// nass.co.uk/about-as/as-facts-and-figures/

Lay Abstract: To appraise the clinical and cost effectiveness of upadacitinib within its marketing authorisation for treatment of active non-radiographic axial spondyloarthritis.

Research Activity Codes: 6.1 PHARMACEUTICALS
Health Categories: INFLAMMATORY AND IMMUNE SYSTEM