Marika Kvarnström

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease causing pain, stiffness, and disability. Current treatment mainly relies on nonsteroidal anti-inflammatory drugs (NSAIDs), which, despite their efficacy, are linked to increased cardiovascular risk. This highlights the need for novel, safer therapies suitable for long-term use. We have developed a targeted anti-inflammatory approach by selectively inhibiting microsomal prostaglandin E synthase-1 (mPGES-1), a downstream enzyme in the cyclooxygenase (COX) pathway. While NSAIDs act upstream by inhibiting COX enzymes, our approach reduces pro-inflammatory prostaglandin E₂ (PGE₂) while preserving cardioprotective prostacyclin (PGI₂). Vipoglanstat, a potent mPGES-1 inhibitor, has completed a Phase I trial and a Phase II trial in systemic sclerosis with excellent safety. We now aim to prepare a randomized trial in axSpA comparing Vipoglanstat to NSAIDs, the current standard of care, to assess effects on disease activity, pain, safety, and biomarkers. This project includes study design, power calculations, national collaboration setup, regulatory and ethical preparations, and integration of biomarker analyses alongside clinical outcomes. We aim to establish a clear path towards a phase II clinical trial, addressing the unmet need for effective and safer treatment options in axSpA, potentially transforming care for these patients.