TOPLINE:

Tofacitinib showed effectiveness in treating ulcerative colitis-associated peripheral spondyloarthritis (SpA), with lower response rates seen in patients with axial SpA.

METHODOLOGY:

• Researchers conducted a prospective study to assess the effectiveness of tofacitinib in 44 adult patients (mean age, 43.7 years; 47.7% men) with ulcerative colitis-associated active SpA recruited across 14 Italian inflammatory bowel disease centres between March 2022 and March 2023.
• Active SpA at baseline was assessed on the basis of the Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (ASDAS-CRP) ≥ 1.3 for axial SpA and a disease activity score (DAS) 28-CRP ≥ 2.6 for peripheral SpA. All but two patients had received biologic therapy previously, with over half receiving two or three such treatments.
• Patients were divided into three groups: those with axial (n = 4), peripheral (n = 31), and mixed (n = 9) SpA; all of them received 10 mg tofacitinib twice daily for an 8-week induction treatment, followed by a maintenance treatment of 5 mg twice daily, with dose optimisation being allowed on the basis of response.
• The primary endpoint was steroid-free joint response at weeks 8 and 52, defined as a decrease of ≥ 1.1 units in ASDAS-CRP for axial SpA or > 0.6 units in DAS28-CRP for peripheral SpA without steroid use.
• Secondary endpoints were ulcerative colitis clinical response, defined as a reduction of at least three points in the partial Mayo score from baseline, and steroid-free clinical remission, defined as a partial Mayo score of ≤ 2 without steroid therapy.

TAKEAWAY:

• At week 8, 52.3% of patients achieved steroid-free joint response, with a significantly higher rate being observed for those in the peripheral SpA group than for those in the axial or mixed SpA group (67.7% vs 15.4%; P = .001).
• By week 52, steroid-free joint response had risen to 59.1% overall, with a higher rate seen in the peripheral SpA group than in the axial or mixed SpA group (71.0% vs 30.8%; P = .01).
• Clinical response was achieved in 59.1% of patients at week 8 and 70.5% at week 52, and steroid-free clinical remission was observed in 34.1% and 45.5% of patients at the respective timepoints.
• Nine patients discontinued the treatment owing to the lack of effectiveness, and one patient stopped it due to a side effect.

IN PRACTICE:

"When IBD [inflammatory bowel disease] and SpA coexist, therapeutic strategies must consider both intestinal and musculoskeletal symptoms. An evidence-based, personalized approach is essential, requiring close collaboration between rheumatologists and gastroenterologists to ensure optimal care," the authors of the study wrote.

SOURCE:

This study was led by Fabio Salvatore Macaluso, "Villa Sofia-Cervello" Hospital, Palermo, Italy. It was published online on August 25, 2025, in Therapeutic Advances in Gastroenterology.

LIMITATIONS:

This study's sample size was small, and it lacked endoscopic data. DAS28-CRP — originally developed for rheumatoid arthritis — was used to assess peripheral SpA.

DISCLOSURES:

This study did not receive any specific funding. Several authors reported receiving financial support for research, lecture and research grants, and consulting fees and being speakers and advisory board members. One author has reported conducting training activities for various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.