TOPLINE

Upadacitinib 15 mg once daily was associated with effective disease control in patients with psoriatic arthritis (PsA) who had previously received one TNF inhibitor. Early pain levels predicted long-term minimal disease activity (MDA) achievement.

METHODOLOGY

• Post hoc analysis of the SELECT-PsA 2 randomized controlled trial evaluated the efficacy and safety of upadacitinib 15 mg once daily vs placebo in patients with PsA and exposure to one prior TNF inhibitor.
• A total of 195 patients who were randomly assigned to upadacitinib 15 mg once daily (n = 90) or placebo (n = 105) were included in the analysis, with placebo patients switching to upadacitinib at week 24.
• The outcomes included at least 20% improvement in American College of Rheumatology response criteria (ACR20)/ACR50/ACR70 responses, MDA, 75%/90% improvement in Psoriasis Area Severity Index Score, and pain assessments.
• Analysis examined the impact of prior TNF inhibitor exposure duration, skin improvement by anatomical location, and early pain response as a predictor of long-term MDA.
• Safety was assessed through treatment-emergent adverse events over 152 weeks.

TAKEAWAY

• At week 24, more patients receiving upadacitinib vs placebo achieved ACR20 (57.8% vs 21.9%), ACR50 (37.8% vs 9.5%), ACR70 (22.2% vs 0%), and MDA (24.4% vs 2.9%).
• Clinical responses were maintained or improved through week 152 in patients initially randomly assigned to upadacitinib.
• Most patients who showed clinical response to daily upadacitinib 15 mg by 24 weeks maintained their improvement at 152 weeks.
• Pain scores at weeks 2 and 12 predicted MDA achievement at week 152, with the area under the curve of 0.751 and 0.771, respectively. Per 100 patient-years, exposure-adjusted treatment-emergent adverse events occurred at a rate of 239.8, serious adverse events at 10.9, serious infections at 2.1, and herpes zoster at 4.8.

IN PRACTICE

"[The] analysis suggests that upadacitinib could be an effective therapeutic alternative to TNF inhibitor cycling for those who have failed one TNF inhibitor therapy, although further research is needed to confirm this," the authors wrote.

SOURCE

The study was led by Laura C. Coates, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust in Oxford, England. It was published online on August 27 in RMD Open.

LIMITATIONS

This was a post hoc analysis of a clinical trial. The study population was restricted to patients with exposure to only one prior TNF inhibitor.

DISCLOSURES

The study was supported by AbbVie. Multiple authors reported consulting fees, research grants, or speaker fees from AbbVie and other pharmaceutical companies including Amgen, Eli Lilly, Janssen, Novartis, Pfizer, and UCB Pharma. Five authors reported being employees of AbbVie and may own company stocks or options. Medical writing support was provided by an AbbVie-funded writer.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.