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AboutAboutHow XELJANZ worksXELJANZ in ActionCytokinesSignalling PathwaysDosingDosingDosing in RADosing in UCDosing in PsADosing in pJIA and jPsADosing in ASSpecial Warnings & PrecautionsEfficacy & SafetyEfficacy & SafetySafety & TolerabilityOral SurveillanceAdverse EventsClinical Efficacy RAORAL Strategy Study DesignORAL Strategy Efficacy ResultsORAL Strategy Safety OutcomesClinical Efficacy UCOCTAVE Study DesignOCTAVE Sub GroupsOCTAVE InductionOCTAVE SustainPost-hoc AnalysesClinical Efficacy PsAOPAL Broaden & BeyondClinical Efficacy pJIA and jPsAJIA-1 Study DesignJIA-1 Efficacy ResultsJIA-1 Safety OutcomesClinical Efficacy ASASAS20/40 DataASDAS(CRP) DataReal World EvidenceReal World EvidenceReal World Evidence
Why Real-World Data?Key Characteristics of RCTs & RWEKey Strengths & Limitations
STAR-RAMalignancy Study DesignMalignancy Risk OutcomesCV Risk Study DesignCV Risk OutcomesSCQM-RAStudy DesignStudy OutcomesCorEvitas RASafety Study DesignEfficacy Study DesignOutcomesUC RWETOUR Registry (US)Honap Study (UK)Tursi Study (Italy)
Supporting ResourcesSupporting ResourcesMaterialsGRAPPA GuidelinesVideosExpert Opinions

XELJANZ® (tofacitinib citrate) Prescribing Information and Maxtrex (methotrexate) Prescribing Information. Adverse event reporting can be found at the bottom of the page.
 
 Tofacitinib should only be used if no suitable treatment alternatives are available in patients:

  • 65 years of age and older;
  • patients with history of atherosclerotic cardiovascular disease or other cardiovascular risk factors (such as current or past long-time smokers);
  • patients with malignancy risk factors (e.g. current malignancy or history of malignancy)

 These risks are considered class effects and relevant across all approved indications of JAKi in inflammatory and dermatologic diseases.

Significant Improvement in disease activity at week 16 vs placebo1Improvement in disease activity (ASDAS[CRP]a,b) was maintained from week 16 through week 481

Adapted from Deodhar et al. 2021.

FAS; MMRM used without imputation for missing values
P<0.001 vs placebo
P≤0.05 vs placebo, according to the prespecified step-down testing procedure for control of ASAS components

a  Post hoc analysis. Score calculated based on CRP level and patient-reported measures: patient global assessment of disease, total back pain, duration of morning stiffness, and peripheral joint pain/swelling. Higher scores indicate more disease activity. A score >3.5 points indicates very high disease activity. A score reduction of at least 1.1 points indicates a clinically important improvement in disease activity.
b  The lower limit of quantification (LLOQ) of the hsCRP assay was 0.2 mg/L. For hsCRP values <LLOQ, they were set to 0.199 mg/L in all efficacy and safety analyses except for the ASDAS-related endpoints, where values <2 mg/L were set post hoc to 2 mg/L.

 

Study Design 1,6

A 48-week, randomized, phase 3 study (consisting of a 16-week double-blind phase, followed by a 32-week open-label phase) including 269 adult patients with active AS and an inadequate response to ≥2 NSAIDs. Randomization was stratified by bDMARD treatment history in patients who had inadequate response to ≤2 TNFis or had prior bDMARD (TNFi or non-TNFi) use without IR. At baseline, 207 patients were bDMARD-naïve, and 62 patients were TNFi-IR or prior bDMARD use (non-IR). NSAIDs/COX-2 inhibitors, MTX, SSZ, or oral corticosteroids were allowed if patients were on a stable dosage at baseline. For patients taking XELJANZ®, the mean age was 42.2 years old (40 years old for placebo), and most patients were male (87.2% for XELJANZ 5 mg BID, 79.4% for placebo). Patients taking XELJANZ in the trial had a mean disease duration since symptoms of 14.2 years (12.9 years for placebo), AS disease duration since diagnosis: mean 8.9 years (6.8 for placebo), and mean baseline BASDAI score: 6.4 (6.5 for placebo). 


The primary endpoint was to evaluate the proportion of patients who achieved an ASAS20 response at week 16. To control for type I error at the 5% level for primary and certain secondary endpoints, 4 families of efficacy endpoints were tested in hierarchical sequences with a step-down approach. The first family, the global type I error–controlled endpoints at week 16, included: ASAS20 response; ASAS40 response; ΔASDAS(CRP); ΔhsCRP, ΔASQoL, ΔSF-36v2 PCS score, ΔBASMI, and ΔFACIT-F total score. Upon meeting statistical significance for ASAS20 response at week 16, the second family included ΔASAS components at week 16, and included testing for ΔPtGA, Δtotal back pain, ΔBASFI, and Δmorning stiffness (inflammation). The third family, ASAS20 response over time, and the fourth family, ASAS40 response over time, were each tested in the following sequence: weeks 16, 12, 8, 4, and 2. In each family, statistical significance could be declared only if the prior endpoint (or time point) in the sequence met the requirements for significance. Nonresponder imputation was applied to missing data for ASAS response rates.

Explore more Find out more about dosing in Psoriatic Arthritis (PsA)Dosing in PsALoading

Δ=change from baseline; AS=ankylosing spondylitis; ASAS=Assessment of SpondyloArthritis international Society; ASDAS(CRP)=Ankylosing Spondylitis Disease Activity Score based on C-reactive protein; ASQoL=Ankylosing Spondylitis Quality of Life; BASDAI=Bath Ankylosing Spondylitis Disease Activity Index; BASFI=Bath Ankylosing Spondylitis Functional Index; BASMI=Bath Ankylosing Spondylitis Metrology Index; bDMARD=biologic disease-modifying antirheumatic drug; BID=twice daily; COX-2=cyclooxygenase 2; CRP=C-reactive protein; FACIT-F=Functional Assessment of Chronic Illness Therapy-Fatigue; FAS=full analysis set; hsCRP=high-sensitivity C-reactive protein; IR=inadequate response; JAKi=Janus kinase inhibitor; LS=least squares; MMRM=mixed model for repeated measures; MTX=methotrexate; N1=number of patients with observation at visit; NSAID=nonsteroidal anti-inflammatory drug; PtGA=Patient Global Assessment of Disease Activity; SD=standard deviation; SF-36v2 PCS=Short Form-36 Health Survey Version 2 Physical Component Summary; SSZ=sulfasalazine; TNFi=tumor necrosis factor inhibitor.

References

Deodhar A, Sliwinska-Stanczyk P, Xu H, et al. Tofacitinib for the treatment of ankylosing spondylitis: a phase III, randomised, double-blind, placebo-controlled study. Ann Rheum Dis. 2021;80(8):1004-1013Sieper J, Rudwaleit M, Baraliakos X, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. [supplementary index II]. Ann Rheum Dis. 2009;68(suppl 2):ii1-ii44.Zochling J. Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). [supplementary index 11]. Arthritis Care Res (Hoboken). 2011;63(suppl 11):S47-S58.Machado P, Landewé R, Lie E, et al. Ankylosing Spondylitis Disease Activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis. 2011;70(1):47-53.Data on file. Pfizer Inc., New York, NY.Deodhar A, Sliwinska-Stanczyk P, Xu H, et al. Tofacitinib for the treatment of ankylosing spondylitis: a phase III, randomised, double-blind, placebo-controlled study [data supplement 2]. Ann Rheum Dis. 2021;80(8):1004-1013. Accessed October 19, 2021. https://ard.bmj.com/content/annrheumdis/suppl/2021/04/28/annrheumdis-2020-219601.DC1/annrheumdis-2020-219601supp002_data_supplement.pdf
XELJANZ Risk Minimisation Programme (RMP) materials, including a Patient Alert Card, Prescriber Checklists and a Prescriber Brochure are available from https://www.medicines.org.uk/emc/. Patients treated with XELJANZ should be given the Patient Alert Card.
PP-XEL-GBR-4267. January 2023
AS Clinical Efficacy

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