Tofacitinib for polyarticular juvenile idiopathic arthritis
Tofacitinib works by blocking the action of enzymes known as Janus kinases. These enzymes play an important role in the inflammatory process. By blocking the enzymes’ action, tofacitinib helps reduce the inflammation and other symptoms of these diseases. Tofacitinib is an oral alternative to the available biological medicines for children with JIA, most of which are administered by injection. If licensed, tofacitinib may offer an additional treatment option for polyarticular JIA with the potential advantage of improving the quality of life of children due to its oral formulation.
Upadacitinib for active psoriatic arthritis with inadequate response to biological or non-biological DMARDs
Upadacitinib is in clinical development for the treatment of adults with active psoriatic arthritis who have an inadequate response to at least one biological or non-biological Disease Modifying Anti-Rheumatic Drug (DMARDs). Psoriatic arthritis is a type of chronic inflammatory arthritis affecting the joints and connective tissue and is associated with psoriasis of the skin or nails. Around two in every five people with psoriasis will develop psoriatic arthritis. Although the exact cause of the disease still remains unknown, it is thought to occur as a result of the immune system mistakenly attacking healthy tissues around the joint and bones. Psoriatic arthritis can get progressively worse and may lead to the joints becoming permanently damaged or deformed.
Guselkumab for active psoriatic arthritis
Guselkumab is a type of biologic medicine that has been designed to suppress immune response associated with psoriasis. It works by specifically targeting a chemical messenger (known as a cytokine) in the body called interleukin-23 (IL-23). The IL-23 are produced by leucocytes (mainly by lymphocytes T, macrophages and eosinophils) in response to mechanical stress, and has an important role in the pathogenesis of psoriasis and psoriatic arthritis. Guselkumab is already licensed in the EU/UK for the treatment of moderate to severe plaque psoriasis and may offer an additional treatment option for patients with active psoriatic arthritis.
Filgotinib for moderate to severe active rheumatoid arthritis
Filgotinib is a new Janus Kinase (JAK) inhibitor. JAK pathways are involved in the inflammatory process in RA. Filgotinib is highly selective for JAK1. By blocking the JAK1 pathway, filgotinib may help ease the RA symptoms. Filgotinib can be taken orally as a tablet once a day and it has shown to be safe. Filgotinib may be taken as monotherapy or in combination with methotrexate or other non-biologic DMARDs. If approved for the treatment of moderate to severe RA, filgotinib will offer an additional front line or a later line treatment option for this population group.
Ixekizumab for axial spondyloarthritis
Ixekizumab is an engineered antibody designed to bind and obstruct the pro-inflammatory interleukin-17A (IL-17A) signalling molecule. It has been suggested that IL-17 may be a crucial mediator of inflammation in the pathway that leads to the development and progression of axial spondyloarthritis. By blocking this pathway, ixekizumab may help prevent joint inflammation, bone erosion, and bone fusion in a patient population where few alternative therapies exist in instances of previous treatment failure.
Tizanidine (Intranasal spray) for Acute Low Back Pain
Tizanidine as an intranasal spray is being developed as a new treatment option for patients with acute low back pain. It works by blocking pain sensations that are sent to the brain, temporarily relaxing muscle tone. Tizanidine is already available in the tablet form as a short-acting muscle relaxer used to relieve the stiffness and restriction of muscles due to injuries or diseases of the spinal cord. If licensed, tizanidine prepared for intranasal administration will offer an alternative to the oral administration for patients with acute low back pain when short term dosing and a fast effect is desired.
Forigerimod plus Standard of Care for Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE) is a long-term condition causing inflammation to the joints, skin and other organs. Symptoms presented are usually very general, including fever, joint pain and skin rash but can progress to the most severe, e.g. kidney failure. SLE typically has patterns of flare-ups where the condition gets worse for a period of time. The disease is likely to be caused by a combination of genetic and lifestyle factors and most commonly affects middle-aged women and those of African-Caribbean ethnicity.
Secukinumab for Non-Radiographic Axial Spondyloarthritis – second or subsequent line
First line treatment options for SpA normally include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, however, these are only effective in approximately half of patients. Secukinumab (Cosentyx) is a new treatment option that acts by inhibiting the processes that leads to bone loss and inflammation, thereby reducing the symptoms of the disease. It is administered by injection under the skin (subcutaneous). If licenced, secukinumab could provide an additional treatment option for patients who are intolerant or do not respond adequately to NSAIDs.