ArticleFrontiers in immunology2026
Clinical efficacy of tofacitinib in active ankylosing spondylitis and dynamic changes in gut microbiota: an exploratory descriptive four-case series with 16S rRNA sequencing analysis.
Article in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To describe short-term clinical outcomes and safety of tofacitinib in four patients with active ankylosing spondylitis (AS) using real-world data, and to explore dynamic changes in gut microbiota before and after treatment. Methods: Four patients with active AS received oral tofacitinib 5 mg twice daily for 6 months. Disease activity [the bath ankylosing spondylitis disease activity index (BASDAI), the ankylosing spondylitis disease activity score calculated with C-reactive protein (ASDAS-CRP)], functional status [the bath ankylosing spondylitis functional index (BASFI)], back pain visual analog scale (VAS), inflammatory markers [CRP, erythrocyte sedimentation rate (ESR)], and adverse events were assessed at baseline and month 6. Paired stool samples were collected for 16S ribosomal ribonucleic acid (rRNA) sequencing to evaluate alpha/beta diversity and compositional changes. Results: After 6 months, all four patients showed marked improvement in disease activity and function: BASDAI decreased from 8.38 ± 0.52 to 2.60 ± 0.38; ASDAS-CRP from 3.85 ± 0.29 to 1.50 ± 0.26. CRP and ESR trended downward, and chest expansion increased. No serious adverse events were observed. Microbiota analysis revealed no consistent changes in alpha diversity or beta diversity clustering; however, individual-level shifts in genera such as Faecalibacterium, Alistipes, and Acidaminococcus were observed. Conclusion: In this exploratory descriptive case series, tofacitinib was associated with favorable short-term clinical outcomes in four patients with active AS. No serious adverse events were noted. Gut microbiota alterations were highly individualized and hypothesis-generating only. Larger controlled studies are warranted to explore potential gut-joint mechanisms.
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