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. 2022 May 30;61(6):2388-2397.
doi: 10.1093/rheumatology/keab758.

Filgotinib decreases both vertebral body and posterolateral spine inflammation in ankylosing spondylitis: results from the TORTUGA trial

Walter P Maksymowych  1 , Mikkel Østergaard  2   3 , Robert Landewé  4   5 , William Barchuk  6 , Ke Liu  6 , Leen Gilles  7 , Thijs Hendrikx  8 , Robin Besuyen  9 , Xenofon Baraliakos  10
Affiliations

Filgotinib decreases both vertebral body and posterolateral spine inflammation in ankylosing spondylitis: results from the TORTUGA trial

Walter P Maksymowych et al. Rheumatology (Oxford). .

Abstract

Objectives: To assess the effects of filgotinib on inflammatory and structural changes at various spinal locations, based on MRI measures in patients with active AS in the TORTUGA trial.

Methods: In the TORTUGA trial, patients with AS received filgotinib 200 mg (n = 58) or placebo (n = 58) once daily for 12 weeks. In this post hoc analysis, spine MRIs were evaluated using the Canada-Denmark (CANDEN) MRI scoring system to assess changes from baseline to week 12 in total spine and subscores for inflammation, fat, erosion and new bone formation (NBF) at various anatomical locations. Correlations were assessed between CANDEN inflammation and clinical outcomes and Spondyloarthritis Research Consortium of Canada (SPARCC) MRI scores and between baseline CANDEN NBF and baseline BASFI and BASMI scores.

Results: MRIs from 47 filgotinib- and 41 placebo-treated patients were evaluated. There were significantly larger reductions with filgotinib vs placebo in total spine inflammation score and most inflammation subscores, including posterolateral elements (costovertebral joints, transverse/spinous processes, soft tissues), facet joints and vertebral bodies. No significant differences were observed for corner or non-corner vertebral body inflammation subscores, spine fat lesion, bone erosion or NBF scores. In the filgotinib group, the change from baseline in the total inflammation score correlated positively with the SPARCC spine score. Baseline NBF scores correlated with baseline BASMI but not BASFI scores.

Conclusions: Compared with placebo, filgotinib treatment was associated with significant reductions in MRI measures of spinal inflammation, including in vertebral bodies, facet joints and posterolateral elements.

Trial registration: ClinicalTrials.gov (https://clinicaltrials.gov), NCT03117270.

Keywords: AS; MRI; filgotinib; inflammation; therapeutics.

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Figures

<sc>Fig</sc>. 1
Fig. 1
Change from baseline in CANDEN MRI score: (A) total spine inflammation score, (B) vertebral body inflammation subscore, (C) posterior elements inflammation subscore, (D) posterolateral elements inflammation subscore, (E) facet joints inflammation subscore, (F) vertebral body corner inflammation subscore, and (G) vertebral body non-corner inflammation subscore
<sc>Fig</sc>. 2
Fig. 2
Short tau inversion recovery MRI at (A) baseline and (B) week 12 from a patient who had received filgotinib. MRI scans demonstrate posterolateral inflammation (top arrow), facet joint inflammation (middle two arrows) and soft-tissue inflammation (bottom arrow) in the lumbar spine that resolved after treatment
See this image and copyright information in PMC

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