Correction to “Poster Abstracts Part B. APLAR 26th Asia-Pacific League of Associations for Rheumatology Congress, 21–25 August 2024”

(2024), Poster Abstracts Part B. Int J Rheum Dis, 27(S3): e15346. https://doi.org/10.1111/1756-185X.15346

The following abstract should be added.

Real-world Insights on Tofacitinib in Ankylosing Spondylitis Amongst Indian Rheumatologists: JOINT Survey.

PD Rath¹, Ashit Syngle², Shyamashis Das³, Pravin Patil⁴, Prasanta Padhan⁵, Ronak Bhuptani⁶, Namita Ghag Wadkar⁶ and Sucheta Mehta⁶.

Author Affiliations:

¹Director and Head of Rheumatology department, Max Super Speciality Hospital, New Delhi, India.

²Consultant Rheumatologist, Fortis Hospital, Mohali, India.

³Consultant Rheumatologist, Institute of Neurosciences, Kolkata, India.

⁴Consultant Rheumatologist, Deenanath Mangeshkar Hospital& Research Center, Pune, India.

⁵Professor, Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India.

⁶Medical Affairs, Cipla Ltd., Mumbai, India.

The wider availability of tofacitinib, a Janus kinase inhibitor (JAKi), has created a paradigm shift in the management of rheumatoid arthritis (RA) in resource-limited settings like India. Real-world data on effectiveness and safety of tofacitinib in ankylosing spondylitis (AS) in the Indian scenario is scarce. The present study aimed to evaluate clinical practice and treatment patterns with tofacitinib in RA and AS amongst Indian rheumatologists.

An online questionnaire-based, nationwide survey was conducted amongst rheumatologists. The internally validated questionnaire included a set of 28 questions to gauge the real-world practices with tofacitinib. This sub-analysis focused on the treatment patterns with tofacitinib in AS.

A total of 107 rheumatologists who dealt with~51–100 AS patients/month across academic institutions, corporate hospitals, and private clinics were included. Short courses of non-steroidal anti-inflammatory drugs (NSAIDs) are primarily used for initial treatment and managing acute flares in AS. Rheumatologists preferred to initiate TNFα inhibitors (36.45%) or sulfasalazine (37.38%) in AS patients post inadequate response to NSAIDs. Interestingly, 39% rheumatologists ranked JAKi viz. tofacitinib as the next preferred option (Figure 1) and 51% have used tofacitinib as monotherapy in AS. Notably, 87% rheumatologists preferred tapering tofacitinib dosage once AS patients achieve low disease activity/remission with down-titration usually to 5 mg OD. Extended-release formulation of tofacitinib (11 mg OD) was preferred by 23% rheumatologists with 75% reporting improved patient compliance (Figure 2A and 2B). More than 70% of rheumatologists rated tofacitinib as good to excellent and 27% rated it as moderate for its efficacy and safety in AS (Figure 2C). Most rheumatologists reported 11%–20% inadequate response and < 5% intolerance to tofacitinib in AS. In such AS patients, rheumatologists (92%) preferred switching to biologics or other JAKi like baricitinib as second choice (50%) or changing to a different brand of tofacitinib as third choice (48%) (Figure 2D). More than 80% rheumatologists recommended complete blood count, liver and kidney function tests, and screening for latent tuberculosis, Hepatitis B and C before initiating tofacitinib. Around 42% rheumatologists have observed major adverse effects, most commonly infections including herpes zoster. Gastrointestinal disturbances and nausea were reported as the most common side effects by 35% rheumatologists followed by upper respiratory tract infections (30%) and lipid alterations (24%).

In AS patients with inadequate response to NSAIDs, TNFα inhibitors/sulfasalazine remained the primary choice of therapy. Insights from this study indicate that Indian rheumatologists are also considering tofacitinib as an option in AS management, favoring its efficacy and safety.

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