EULAR 2026 Highlights – Spondyloarthritis (therapeutic)

Filgotinib significantly improves disease activity in patients with active axial spondyloarthritis: primary results from the phase 3 OLINGUITO trial

Abstract format and assignment number: Oral presentation OP0234

Presenting author: X. Baraliakos (Germany)

The Phase 3 OLINGUITO trial demonstrated that filgotinib 200 mg once daily, an oral JAK1 preferential inhibitor, significantly improved disease activity in patients with both radiographic and non-radiographic axial spondyloarthritis (axSpA). Compared with placebo, filgotinib achieved early and clinically meaningful improvements by week 16, including higher ASAS40 response rates, lower ASDAS scores, and reduced MRI sacroiliac joint inflammatory lesions. These benefits were maintained or further enhanced through week 52. Filgotinib was generally well tolerated, with a safety profile consistent with previous studies and no new safety concerns identified. Overall, the results support a favourable benefit–risk profile for filgotinib in patients with active axSpA.

No superiority of IL-17A inhibitors compared with TNF inhibitor cycling after failure of a first TNF inhibitor in axial spondyloarthritis: results from the ROC-SpA study

Abstract format and assignment number: Oral presentation OP0235

Presenting author: H. Marotte (France)

The hypothesis that an IL-17A inhibitor is superior to a second TNF inhibitor (TNFi) in patients with axial spondyloarthritis (axSpA) who failed a first TNFi was evaluated in a prospective, multicentre, randomised, single-blind phase IV superiority trial. The study did not demonstrate superiority of IL-17A inhibition over switching to a second TNFi after failure of a first TNFi in axSpA. These findings provide further evidence that treatment strategies in axSpA may differ from those established in rheumatoid arthritis. Treatment decisions should therefore be individualised, taking into account patient preferences, disease phenotype, and shared decision-making. Importantly, the absence of superiority should not be interpreted as therapeutic equivalence. Whether these results can be extrapolated to dual IL-17A/F inhibitors or JAK inhibitors remains uncertain and warrants further investigation.

Ivarmacitinib, a selective JAK1 inhibitor, in active non-radiographic axial spondyloarthritis: a multicentre, randomized, double-blind, placebo-controlled phase 3 trial

Abstract format and assignment number: Oral presentation OP0237

Presenting author: X. Zhang (China)

In adults with active non-radiographic axial spondyloarthritis (nr-axSpA) and an inadequate response or intolerance to NSAIDs, ivarmacitinib 4 mg once daily significantly improved signs, symptoms, and disease activity compared with placebo at week 12. Clinical improvements were maintained through week 24, and ivarmacitinib was generally well tolerated. These phase 3 results support selective JAK1 inhibition with ivarmacitinib as an effective oral treatment option for patients with nr-axSpA and objective signs of inflammation.

Risk of cancer according to duration of targeted therapy exposure in spondyloarthritis: a nationwide cohort study from the French health insurance database

Abstract format and assignment number: Oral presentation OP0238

Presenting author: K. Tankovic (France)

This study evaluated the association between the duration of exposure to targeted therapies and the risk of cancer in patients with spondyloarthritis (SpA), including both solid tumours and haematological malignancies. Secondary analyses explored whether this association differed according to SpA subtype, particularly psoriatic arthritis, and assessed the impact of TNF inhibitor exposure separately. Overall, the results provide reassuring evidence regarding the long-term safety of targeted therapies in SpA. Prolonged exposure to targeted treatment (>6 months/year) was associated with a lower risk of cancer, with the strongest effect observed for haematological malignancies. These findings may reflect better disease control and reduced systemic inflammation among patients receiving sustained treatment.

Efficacy and safety of gecacitinib, a novel JAK inhibitor, in patients with active radiographic axial spondyloarthritis: results from a randomized, double-blind, placebo-controlled, multicentre phase 3 clinical trial

Abstract format and assignment number: Oral presentation OP0240

Presenting author: C. Bao (China)

In this phase 3 trial, gecacitinib achieved the primary endpoint, significantly improving ASAS40 responses at week 16 versus placebo in patients with active radiographic axial spondyloarthritis (r-axSpA). Efficacy was consistent across secondary outcomes and patient subgroups, including those previously exposed to bDMARDs. With a favourable safety profile and no new safety signals, gecacitinib emerges as a promising oral treatment option for active r-axSpA.

Tofacitinib in early axial spondyloarthritis: results from the randomized, double-blind, placebo-controlled, multicentre phase IV study, FASTLANE

Abstract format and assignment number: Oral presentation OP0241

Presenting author: V. Rios Rodriguez (Germany)

In patients with early active axial spondyloarthritis (axSpA; ≤2 years’ disease duration), tofacitinib demonstrated superior efficacy to placebo in achieving inactive disease (ASDAS <1.3) at week 16 when added to a background of naproxen therapy. Fewer patients receiving tofacitinib required treatment escalation to open-label therapy compared with those receiving placebo. Improvements were consistently observed across clinical, imaging, and disease activity outcomes. The safety profile of tofacitinib was consistent with previous studies in radiographic axSpA, with no new safety concerns identified. These findings support the efficacy of early JAK inhibition with tofacitinib as a treatment strategy for patients with early active axSpA.