TY - JOUR
T1 - Impact of filgotinib on sacroiliac joint magnetic resonance imaging structural lesions at 12 weeks in patients with active ankylosing spondylitis (TORTUGA trial)
AU - Maksymowych, Walter P
AU - Østergaard, Mikkel
AU - Landewé, Robert
AU - Barchuk, William
AU - Liu, Ke
AU - Tasset, Chantal
AU - Gilles, Leen
AU - Hendrikx, Thijs
AU - Besuyen, Robin
AU - Baraliakos, Xenofon
N1 - COPECARE
© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.
PY - 2022/5/5
Y1 - 2022/5/5
N2 - OBJECTIVE: To assess the effect of filgotinib, which preferentially inhibits Janus kinase 1 (JAK1), on MRI measures of structural change in the SI joint in patients with active AS in the TORTUGA trial.METHODS: Adults with active AS and inadequate response/intolerance to two or more NSAIDs were randomized 1:1 to filgotinib 200 mg (n = 58) or placebo (n = 58) once daily for 12 weeks. In this post hoc analysis, T1-weighted MRI scans of the SI joint were evaluated by two independent readers using Spondyloarthritis Research Consortium of Canada (SPARCC) Sacroiliac Joint Structural Score (SSS) definitions for erosion, backfill, fat metaplasia and ankylosis. Correlations between SPARCC SSS and improvement in clinical outcomes were also assessed.RESULTS: MRI scans from 87 patients (48 filgotinib, 39 placebo) were evaluated. At baseline there were no notable differences between filgotinib and placebo for any MRI structural lesion types. From baseline to week 12, filgotinib was associated with a significant reduction in SI joint erosion score (P = 0.02) and an increase in backfill score (P = 0.005) vs placebo, with no significant between-group differences for ankylosis (P = 0.46) or fat metaplasia (P = 0.17). At week 12, the change in SPARCC MRI SI joint inflammation scores correlated positively with erosion scores but negatively with backfill scores.CONCLUSION: The significant changes in MRI structural lesions induced by filgotinib in the SI joint by week 12 demonstrate that tissue repair can be observed very soon after starting treatment with a JAK1 preferential inhibitor. This could have prognostic implications for development of ankylosis.TRIAL REGISTRATION: ClinicalTrials.gov, http://clinicaltrials.gov, NCT03117270.
AB - OBJECTIVE: To assess the effect of filgotinib, which preferentially inhibits Janus kinase 1 (JAK1), on MRI measures of structural change in the SI joint in patients with active AS in the TORTUGA trial.METHODS: Adults with active AS and inadequate response/intolerance to two or more NSAIDs were randomized 1:1 to filgotinib 200 mg (n = 58) or placebo (n = 58) once daily for 12 weeks. In this post hoc analysis, T1-weighted MRI scans of the SI joint were evaluated by two independent readers using Spondyloarthritis Research Consortium of Canada (SPARCC) Sacroiliac Joint Structural Score (SSS) definitions for erosion, backfill, fat metaplasia and ankylosis. Correlations between SPARCC SSS and improvement in clinical outcomes were also assessed.RESULTS: MRI scans from 87 patients (48 filgotinib, 39 placebo) were evaluated. At baseline there were no notable differences between filgotinib and placebo for any MRI structural lesion types. From baseline to week 12, filgotinib was associated with a significant reduction in SI joint erosion score (P = 0.02) and an increase in backfill score (P = 0.005) vs placebo, with no significant between-group differences for ankylosis (P = 0.46) or fat metaplasia (P = 0.17). At week 12, the change in SPARCC MRI SI joint inflammation scores correlated positively with erosion scores but negatively with backfill scores.CONCLUSION: The significant changes in MRI structural lesions induced by filgotinib in the SI joint by week 12 demonstrate that tissue repair can be observed very soon after starting treatment with a JAK1 preferential inhibitor. This could have prognostic implications for development of ankylosis.TRIAL REGISTRATION: ClinicalTrials.gov, http://clinicaltrials.gov, NCT03117270.
KW - ankylosing spondylitis
KW - filgotinib
KW - inflammation
KW - magnetic resonance imaging
KW - sacroiliac joint
KW - therapeutics
KW - Pyridines
KW - Spondylarthritis/drug therapy
KW - Sacroiliac Joint/diagnostic imaging
KW - Humans
KW - Janus Kinase Inhibitors/therapeutic use
KW - Magnetic Resonance Imaging/methods
KW - Triazoles
KW - Adult
KW - Metaplasia/pathology
KW - Spondylitis, Ankylosing/drug therapy
UR - http://www.scopus.com/inward/record.url?scp=85129997554&partnerID=8YFLogxK
U2 - 10.1093/rheumatology/keab543
DO - 10.1093/rheumatology/keab543
M3 - Journal article
C2 - 34352069
SN - 1462-0324
VL - 61
SP - 2063
EP - 2071
JO - Rheumatology (Oxford, England)
JF - Rheumatology (Oxford, England)
IS - 5
ER -