Upadacitinib in difficult-to-treat PsA: A long-term, real-world study

Results from a 104-week, single-center, observational, retrospective, real-world study evaluating upadacitinib monotherapy in 25 patients with difficult-to-treat psoriatic arthritis (PsA) with ultrasound-detectable joint inflammation were published in Psoriasis: Targets and Therapy by Graceffa et al. Difficult-to-treat PsA was defined as failure of at least one conventional synthetic disease-modifying antirheumatic drug (csDMARD) and two biologic DMARDs (bDMARDs) with different mechanisms of action. The aims of this study were to determine the efficacy, safety, and treatment persistence of upadacitinib in this patient population. 

Key data: Treatment persistence at 104 weeks was 68%. Mean clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA) decreased from 27.88 ± 5.2 at baseline to 4.88 ± 4.54 at Week 52 and 5.76 ± 4.56 at Week 104 (intention-to-treat – last observation carried forward [ITT-LOCF], p < 0.001). At Week 52, 70.6% of patients achieved complete remission (CR), with 94.1% maintaining CR or low disease activity at Week 104. The European Alliance of Associations for Rheumatology–Outcome Measures in Rheumatology (EULAR–OMERACT) ultrasound score decreased significantly from 2.24 ± 0.52 at baseline to 0.71 ± 0.59 at Week 52 (ITT-LOCF, p < 0.001). Improvements in Psoriasis Area and Severity Index (PASI) were also observed over 104 weeks (p < 0.001). Abnormal lipid profile (32%) and increased creatine phosphokinase (CPK) levels (16%) were the most common adverse events (AEs); neither abnormality required pharmacological intervention. 

Key learning: Upadacitinib demonstrated rapid, sustained clinical and ultrasound measures of disease activity over 104 weeks with a favorable safety profile. These findings provide supportive real-world evidence for the use of upadacitinib in patients with PsA refractory to DMARDs.