EFFICACY AND SAFETY OF UPADACITINIB IN PATIENTS WITH PSORIATIC ARTHRITIS AND AXIAL INVOLVEMENT
Authors: A. Deodhar et al.
Upadacitinib has recently been approved for treatment of patients with axial spondyloarthritis and psoriatic arthritis. Approval was based on the results of two phase III clinical trials, SELECT-PsA1 (1705 patients, non-biologic DMARD-IR) and SELECT-PsA2 (642 patients, biologic DMARD-IR) in patients with active disease. Prevalence of axial involvement was 31.3% in SELECT-PsA1 and 34.2% in SELECT-PsA2. Patients with axial involvement had higher baseline disease burden compared to those without axial involvement. In comparison to placebo, upadacitinib resulted in significant improvement from baseline until week 12 and 24 with regard to BASDAI, patients assessment of inflammatory neck, back or hip pain (BASDAI Q2), ASDAS-CRP and proportion of patients with BASDAI50 response.
There is growing evidence that patients with psoriatic arthritis with axial involvement have a higher disease burden in comparison to patients without axial involvement. Not all of the available treatment options for patients with psoriatic arthritis may improve axial disease. The current analysis demonstrates that axial disease occurs in almost a third of all PsA patients regardless of whether the population of patients had previously failed to biologics or not. Of note, upadacitinib was effective in patients with and without axial involvement and led to improvement of BASDAI, an increased proportion of patients with ASDAS low disease activity, ASDAS major improvement and ASDAS clinically important improvement.
Given the efficacy of upadacitinib in patients with axial spondyloarthritis, this data is reassuring and demonstrates that axial involvement may represent a disease manifestation that is relevant for patients and may impact treatment decisions