Background/Purpose: Upadacitinib (UPA), an oral JAK inhibitor, has demonstrated efficacy for the treatment of PsA in randomized controlled trials of patients with inadequate response or intolerance to biologic DMARDs¹; however, there remains limited real-world data on the effectiveness of UPA. This study assessed real-world improvement in key clinical and patient-reported outcomes (PROs) among adult PsA patients initiating UPA after prior experience with a TNF inhibitor.

Methods: The OM1 PsA registry (January 2013-March 2024) was used to identify TNF inhibitor-experienced PsA patients who initiated UPA on or after December 14, 2021. The OM1 PsA Registry (OM1, Inc; Boston, MA) follows > 60k PsA patients in the US managed by rheumatologists longitudinally with clinical data and linked administrative claims. Inclusion criteria were defined as ≥ 18 years of age, ≥ 1 UPA claim (index date defined as the first UPA claim), ≥ 1 claim of TNF inhibitor before index date, ≥ 6 months of available data before index date (ie, baseline period), ≥ 1 baseline outcome measure, and ≥ 1 follow-up outcome measure (3- or 6-months post index). Mean changes from baseline were evaluated at both 3 and 6 months for the following clinical outcomes and PROs: RAPID3, TJC28, SJC28, pain by visual analog scale (VAS: 0-10), fatigue by numeric rating scale (NRS: 0-10), Multi-Dimensional Health Assessment Questionnaire (MDHAQ) Physician Global Assessment (PGA: 0-10), and MDHAQ Patient Global Assessment (PtGA: 0-10). For each outcome, paired t tests were performed to test the difference between the baseline and follow-up scores at 3- and 6-months post index.

Results: A total of 535 TNF inhibitor-experienced patients with PsA met the inclusion criteria. Mean patient age was 55.2 years, 73% of patients were female, and 95% were White. Most patients were covered under commercial insurance (73%), followed by Medicare (24%), and Medicaid (3%) (Table 1). At baseline, overall mean ± SD scores were 4.45 ± 2.23 for RAPID3, 5.97 ± 7.15 for TJC28, 3.13 ± 4.56 for SJC28, 5.71 ± 2.62 for pain, 5.95 ± 2.61 for fatigue, 3.54 ± 2.60 for MDHAQ PGA, and 5.21 ± 2.67 for MDHAQ PtGA. At 3 months, significant improvements (all P < 0.05) were observed for all the clinical outcomes and PROs: RAPID3 (-0.44 ± 2.02), TJC28 (-1.82 ± 6.09), SJC28 (-0.97 ± 3.29), pain (-0.85 ± 2.48), fatigue (-0.73 ± 2.13), MDHAQ PGA (-0.72 ± 2.39), and MDHAQ PtGA (-0.53 ± 2.62) (Table 2). The improvements at 3 months were maintained at 6 months.

Conclusion: TNF inhibitor-experienced patients with PsA who initiated UPA demonstrated significant and sustained improvements in joint involvement, pain, fatigue, and overall health in real-world clinical practice.

Reference:
1. Mease PJ, et al. Ann Rheum Dis. 2021;80:312-20.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-world-effectiveness-of-upadacitinib-in-patients-with-psoriatic-arthritis-previously-treated-with-tnf-inhibitors-data-from-the-om1-registry/