NICE Recommends RINVOQ®▼(upadacitinib) As A Treatment Option For Active Ankylosing Spondylitis (AS) In Adults


Publication of a optimistic Final Appraisal Document (FAD) means RINVOQ®▼(upadacitinib) can be out there in England and Wales as a therapy choice for energetic ankylosing spondylitis in adults that isn’t managed properly sufficient with standard remedy, provided that tumour necrosis issue (TNF)-alpha inhibitors usually are not appropriate or don’t management the situation properly sufficient[i]
AS is a persistent, inflammatory musculoskeletal illness primarily affecting the backbone and characterised by debilitating signs of ache, restricted mobility, structural harm and fatigue[ii]
There is a excessive un-met medical want in AS, significantly in sufferers who’ve an insufficient response to bDMARDs. Effective oral therapy choices apart from non-steroidal anti-inflammatory drug (NSAIDs) are scarce.



MAIDENHEAD, UK, 17 AUGUST 2022 – The National Institute for Health and Care Excellence (NICE) has issued a optimistic Final Appraisal Document (FAD) recommending upadacitinib 15 mg extended launch pill, a once-daily oral remedy, as an choice for treating energetic ankylosing spondylitis in adults, which isn’t managed properly sufficient with standard remedy.1

In AS, adjustments to the sacroiliac joints or the backbone will be seen on X-ray. AS is a painful, progressive type of inflammatory arthritis primarily affecting the backbone, however which may additionally have an effect on different joints, tendons and ligaments.2  Typical signs embody gradual or gradual onset of again ache and stiffness over weeks or months. The present common delay to prognosis from when signs begin is 8.5 years, by which era irreversible harm to the backbone could have occurred.2 AS or radiological axial SpA (axSpA) is extra incessantly identified in males in contrast with girls (3:1).[iii]

This NICE advice is predicated on knowledge from the pivotal SELECT-AXIS 1[iv] and a pair of medical trials.[v] There are an estimated 33,000 – 154,000 adults with AS within the UK.2  NICE’s advice follows the granting of Marketing Authorisation for upadacitinib in AS in January 2021.[vi]

Professor Raj Sengupta, Consultant Rheumatologist and Clinical Lead for Axial Spondyloarthritis, from Royal United Hospitals, Bath commented, “AS is a progressive illness and with out efficient therapy can result in growing ache and lack of operate. Treating AS as early as potential is vital to sustaining a very good high quality of life. This advice from NICE is welcome information which is able to present a further therapy choice to assist individuals acquire management of their AS.”

Dale Webb, Chief Executive, the National Axial Spondyloarthritis Society (NASS) stated, “We see the affect that this illness and delays in receiving applicable care can have daily. We welcome this choice by NICE. The availability of extra therapy choices for AS has the potential to alter the lives of individuals with AS and their households.”

Commenting on the advice, Belinda Byrne, Medical Director at AbbVie UK, stated, “We are happy that by working carefully with NICE, now we have been in a position to show the worth that upadacitinib can carry to sufferers with AS. For over 20 years, now we have been devoted to bettering the outcomes of individuals with AS and different immune-mediated illnesses.” 

The choice expands entry to upadacitinib for individuals dwelling with inflammatory musculoskeletal situations in England and Wales: NICE beforehand granted a optimistic advice as a therapy choice for upadacitinib in extreme energetic rheumatoid arthritis (RA) in 2020[vii], average RA in 2021[viii] and Psoriatic arthritis (PsA) in 2022.[ix]


The publication of this steerage as a Fast Track Appraisal comes after AbbVie engaged with NICE and the medical and affected person communities to show the medical profit and worth of upadacitinib in AS.

[i] NICE Rinvoq AS FAD – Upadacitinib for treating active ankylosing spondylitis [ID3848]

[ii] NASS. What is AS? Available from: https://nass.co.uk/about-as/what-is-as/ [Last accessed: August 2022]

[iii] Rusman T, Bentum RE, van der Horst-Bruinsma I. Sex and gender variations in axial spondyloarthritis: myths and truths. Rheumatology, Volume 59, Issue Supplement_4, October 2020, Pages iv38–iv46

[iv] Van der Heijde D, et al. Efficacy and security of upadacitinib in sufferers with energetic ankylosing spondylitis (SELECT-AXIS 1): a multicentre, randomised, double-blind, placebo-controlled, part 2/3 trial. Lancet. 2019 Dec 7;394(10214):2108-2117. doi: 10.1016/S0140-6736(19)32534-6. Epub 2019 Nov 12.

[v] Deodhar A, et al.  Upadacitinib for the therapy of energetic non-radiographic axial spondyloarthritis (SELECT-AXIS 2): a randomised, double-blind, placebo-controlled, part 3 trial. Lancet 2022; 400: 369–79

[vi] RINVOQ (upadacitinib) Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/10972 [Last Accessed: August 2022]

[vii] Upadacitinib for treating extreme rheumatoid arthritis. Technology appraisal steerage [TA665] Published: 09 December 2020 https://www.nice.org.uk/guidance/ta665/ [Last Accessed: August 2022]

[viii] Upadacitinib for treating average rheumatoid arthritis. Technology appraisal steerage [TA744] Published: 10 November 2021.  https://www.nice.org.uk/guidance/ta744 / [Last Accessed: August 2022]

[ix] NICE. Upadacitinib for treating energetic psoriatic arthritis after insufficient response to DMARDs. Available from: https://www.nice.org.uk/guidance/ta768 [Last Accessed: August 2022]


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By Seth A. Dunbar

Seth Dunbar leads clinical research study operations and quality & compliance. He is experienced working with teams to help drug sponsors better leverage eSource data. With 10+ years of experience Seth brings expertise developing eClinical services that integrate data and technology to help companies optimise study execution.

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