Upadacitinib Shows Superior Benefits in Treating Active AS

Rates of clinical response were higher, and costs were lower, with upadacitinib compared with other advanced therapies in patients with active ankylosing spondylitis (AS), according to results from a network meta-analysis published in Rheumatology and Therapy.

“This study is the first to compare the clinical and economic benefit among approved advanced therapies for the treatment of AS,” wrote corresponding author Jessica A. Walsh, MD, of the Veterans Affairs Medical Center and University of Utah in Salt Lake City, Utah, and study coauthors. “Our findings suggest upadacitinib may provide greater clinical and economic benefit in AS regardless of treatment status with biologic therapies.”

The network meta-analysis included 21 phase III randomized clinical trials. Therapies compared to upadacitinib included the Janus kinase inhibitor tofacitinib, the anti-interleukin-17 therapies secukinumab and ixekizumab, and the tumor necrosis factor (TNF) inhibitors adalimumab, etanercept, and golimumab.

Among patients naïve to biologic disease-modifying antirheumatic drugs (bionaïve), 53.6% of those treated with upadacitinib achieved Assessment of Spondyloarthritis International Society 40 (ASAS40) criteria. ASAS40 response rates for most other treatments were between 41% and 49%, according to the study. Numbers needed to treat were 2.8 for upadacitinib compared with between 3.2 and 4.8 for other therapies.

Cost per ASAS40 responder, calculated as 12-week treatment costs divided by ASAS40 response rates, were an estimated $39.5k with upadacitinib compared with between $44.2k and $102.5K for other treatments for patients who were bionaïve.

The meta-analysis found similar ASAS40 response and cost-per-responder trends among patients with inadequate response or intolerance to biologic disease-modifying antirheumatic drugs (bio-IR) and TNF inhibitors.

Upadacitinib and secukinumab had the lowest rates of adverse events leading to discontinuation among patients who were bionaïve and bio-IR.

“Further analyses are warranted to confirm these findings via head-to-head or real-world comparisons of these therapies for patients with AS,” researchers wrote, “as such data may be helpful to inform clinical decision-making when considering treatment options for patients with AS.”

Reference:
Walsh JA, Saffore CD, Collins EB, Ostor A. Clinical and economic benefit of advanced therapies for the treatment of active ankylosing spondylitis. Rheumatol Ther. 2023;10(5):1385-1398. doi:10.1007/s40744-023-00586-6