Background/Purpose: RAPID3 (Routine Assessment of Patient Index Data 3) is a dis­ease activity index calculated from 3 patient-reported measures: phys­ical function, pain, and patient global assessment. RAPID3 is applicable to multiple rheu­matic diseases, including psoriatic arthritis (PsA), and was shown to correlate with other clinical composite measures of disease activity¹. We assessed the long-term effect of upadacitinib (UPA), and adalimumab (ADA) on RAPID3 scores in patients with PsA via a post hoc analysis from the SELECT-PsA 1 trial^2,3.

Methods: Data from double-blind SELECT-PsA 1 trial, in which patients with PsA and inadequate response or intolerance to ≥1 non-bi­ologic DMARD received UPA 15mg or 30mg once daily, ADA 40mg every other week (wk), or placebo (PBO; switched at wk24 to either UPA 15mg or 30mg). Included data from the UPA 15mg, ADA, and PBO treat­ment arms. RAPID3 endpoints were calculated using pain scores, patient’s global assessment of disease activity, and HAQ-DI (each rescaled to 0–10 in this analysis); summed together, RAPID3 scores range from 0 (no disease activity) to 30 (severe activity). Mean change from baseline (BL) in RAPID3 and proportions of patients reporting minimal clinically important differences (MCID) in RAPID3 and RAPID3 remission (≤3), low (LDA, >3 to ≤6), moderate (MDA, >6 to ≤12), and high disease activity (HDA, >12) were assessed through wk 56. Associations between RAPID3 scores and disease activity in psoriatic arthritis (DAPSA) and Minimal Disease Activity (MDA)/Very Low Disease Activity (VLDA) were determined by Mantel-Haenszel chi-square test. All data are as observed.

Results: A total of 1,274 patients (PBO: n=421; UPA 15mg: n=425; ADA: n=428) were included from SELECT-PsA 1. RAPID3 scores at BL were com­parable across all treatment arms, and most patients were in HDA. Patients receiving UPA showed greater improvement from BL in RAPID3 vs ADA at all visits from wk16 to wk56 and better responses vs PBO at all assessments (Figure 1). A higher proportion of patients treated with UPA achieved MCID in RAPID3 scores than those on ADA from wk24 to wk56. By wk56, approximately half of patients on either therapy were in RAPID3 remission or LDA, with UPA showing a slight numerical improvement relative to ADA (30/21/31/18% of patients were in remission/LDA/MDA/HDA on UPA vs 28/17/30/25% on ADA). RAPID3 disease categories were strongly associated with DAPSA and MDA/VLDA status at wk56 across all treatment arms pooled together (Table 1) and for the UPA 15mg arm alone (nominal P < 0.0001 for all associations).

Conclusion: UPA 15mg treatment led to greater improvements over PBO in RAPID3 scores over 56wks in patients with PsA, and greater improvements over ADA from wk16 to 56. The majority of patients achieved MCID in RAPID3 after 12wks of UPA or ADA, with higher proportions achieving MCID on UPA vs ADA by wk24. RAPID3 was strongly associated with other joint-focused (DAPSA) or multiple manifestation (MDA/VLDA) composite measures, further supporting the utility of RAPID3 in assessing disease activity in PsA.

References
1. Coates LC, et al. Arthritis Care Res 2018;70:1198-1205
2. McInnes IB, et al. N Engl J Med 2021;384:1227-39
3. McInnes IB, et al. RMD Open 2021;7:e001838

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/upadacitinib-versus-adalimumab-on-routine-assessment-of-patient-index-data-3-rapid3-in-patients-with-psoriatic-arthritis/