Upadacitinib in PsA With Axial Involvement
Patients with psoriatic arthritis (PsA) and axial involvement treated with upadacitinib showed greater responses versus placebo, and numerically similar or greater responses compared to adalimumab, according to a post-hoc analysis of SELECT-PsA 1 and SELECT-PsA 2 clinical trial data.
The researchers analyzed data for patients randomized to upadacitinib 15 mg (UPA15), placebo (switched to UPA15 at week 24), or adalimumab 40 mg (ADA; SELECT-PsA 1 only), who were determined to have axial involvement according to investigator judgment alone—such as duration and characteristics of back pain, age of onset, and previous lab investigations and imaging—or investigator judgment and patient-reported outcome criteria.
The team evaluated efficacy outcomes, including change from baseline measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) or proportion of patients achieving BASDAI 50 (≥ 50% improvement from baseline); and mean change from baseline in Ankylosing Spondylitis Disease Activity Score (ASDAS) score or proportion of patients achieving ASDAS inactive disease or low disease activity. Patients were evaluated at weeks 12, 24, and 56.
The authors reported that “30.9% of patients in SELECT-PsA 1 and 35.7% in SELECT-PsA 2 had axial involvement by investigator judgement alone; 22.6% (SELECT-PsA 1) and 28.6% (SELECT-PsA 2) had axial involvement by investigator judgement and PRO-based criteria. Greater proportions of patients achieved BASDAI 50 with UPA15 versus placebo using either criterion, and versus ADA using investigator judgement alone, at week 24 in SELECT-PsA 1 (investigator alone: UPA15, 59.0%, placebo, 26.9%, P < 0.0001, ADA, 44.1%, P = 0.015; investigator and PRO-based: UPA15, 60.4%, placebo, 29.3%, P < 0.0001, ADA, 47.1%, P = 0.074), with comparable findings in SELECT-PsA 2.”
The rates of treatment-emergent adverse events were generally similar in subgroups regardless of axial involvement.
—Rebecca Mashaw
Reference:
Baraliakos X, Ranza R, Östör A, et al. Efficacy and safety of upadacitinib in patients with active psoriatic arthritis and axial involvement: results from two phase 3 studies. Arthritis Res Ther. 2023;25(1):56. doi: 10.1186/s13075-023-03027-5.
