Title: Upadacitinib for treating active Ankylosing spondylitis (ID3848)
Funder: Department of Health and Social Care

Abstract: Ankylosing spondylitis 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). People with these diseases often have the genetic marker human leukocyte antigen (HLA)-B27._x000D_ _x000D_ The clinical symptoms can vary from person to person, but usually develop slowly over several months or years. The main symptoms can include back pain, usually inflammatory in nature, arthritis (inflammation of the joins in other parts of the body), enthesitis (inflammation where a bone is joined to a tendon), and fatigue._x000D_ _x000D_ In the early stages of disease, radiographs of the sacroiliac joints and spines can be normal (so-called ‘non-radiographic’ disease) although sacroiliitis (inflammation of the sacroiliac joints) or inflammation of the spine may be visible on MRI before structural damage occurs. If definite radiographic sacroiliitis (abnormalities are seen in plain xrays of the sacroiliac joints, such as erosions, sclerosis, and partial or total ankylosis) is present, the disease can be classified as ankylosing spondylitis. Radiographic changes to the spine are not part of the classification criteria, but new bone formation (such as syndesmophytes and ankylosis of the vertebral column) is characteristic of ankylosing spondylitis._x000D_ _x000D_ The prevalence of ankylosing spondylitis in the UK is thought to range from 0.05% to 0.23%. Based on population estimations in 2020, there are between 33,398 and 153,632 adults with ankylosing spondylitis in the UK.[1] Ankylosing spondylitis is about three times more common in men than in women, but men are more likely to develop radiographically evidence disease. The onset of symptoms typically occurs in the third decade of life._x000D_ _x000D_ Conventional therapy for ankylosing spondylitis includes non-steroidal antiinflammatory drugs (NSAIDs) and physiotherapy. Tumour necrosis factor-alpha (TNF-alpha) inhibitors are typically used when the disease has not responded adequately to conventional therapy. NICE technology appraisal TA383 recommends adalimumab, certolizumab pegol, etanercept, golimumab and infliximab as treatment options for adults with severe active ankylosing spondylitis for people who have active spinal disease as assessed on two separate occasions 12 weeks apart and have tried at least two NSAIDs but they have not worked. Biosimilar versions of adalimumab, etanercept and infliximab are available. Infliximab is only recommended if the least expensive infliximab product is used. NICE technology appraisal 407 recommends secukinumab for treating active ankylosing spondylitis in adult whose disease has responded inadequately to conventional therapy (NSAIDs or TNF-alpha inhibitors). _x000D_ _x000D_ References_x000D_ 1 NIHR (2020) Health Technology Briefing: Tofactinib for Ankylosing Spondylitis

Lay abstract: To appraise the clinical and cost effectiveness of upadacitinib within its marketing authorisation for treatment of active ankylosing spondylitis in adults who have responded inadequately to conventional therapy.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: MUSCULOSKELETAL