Greater Outcomes for PsA Observed With Upadacitinib vs Adalimumab
Among patients with psoriatic arthritis (PsA), patients receiving upadacitinib (UPA) demonstrated greater improvement from baseline in Rapid Assessment of Patient Index Data 3 (RAPID3) scores vs adalimumab (ADA) at all visits from week 16 to week 56 and better responses vs placebo (PBO), according to a post hoc analysis presented at the recent American College of Rheumatology Convergence 2022.
In the study, researchers evaluated the long-term effect of UPA and ADA on RAPID3 scores in patients with PsA from the double-blind SELECT-PsA 1 trial. RAPID3 is a disease activity index calculated from 3 patient-reported measures: physical function, pain, and patient global assessment.
In the trial, patients with PsA and inadequate response or intolerance to one or greater nonbiologic disease modifying anti-rheumatic drugs (DMARD) received UPA 15 mg or 30 mg once daily, ADA 40mg every other week, or placebo (which was switched at week 24 to either UPA 15 mg or 3 0mg). The study included a total of 1274 patients, of which 421 received PBO, 425 received UPA 15 mg, and 428 received ADA. RAPID3 scores at baseline were comparable across all treatment arms, and most patients were classified as having high disease activity.
The results indicated that patients receiving UPA demonstrated greater improvement from baseline in RAPID3 vs ADA at all visits from week 16 to week 56 and better responses vs PBO at all assessments. The study also revealed that a greater percentage of patients treated with UPA achieved minimal clinically important differences in RAPID3 scores than those on ADA from week 24 to week 56.
By week 56, an estimated 50% of patients on either therapy were in RAPID3 remission or low disease activity, with UPA revealing a slight numerical improvement relative to ADA:
- 30% of patients were in remission on UPA vs 28% on ADA
- 21% of patients had low disease activity on UPA vs 17% on ADA
- 31% of patients had moderate disease activity on UPA vs 30% on ADA
- 18% of patients had high disease activity on UPA vs 25% on ADA
RAPID3 disease categories were robustly correlated with disease activity in psoriatic arthritis and moderate/very low disease activity status at week 56 across all treatment arms pooled collectively and for the UPA 15mg arm alone (nominal p < .0001 for all associations).
The authors indicated that during 56 weeks in patients with PsA, UPA 15 mg treatment resulted in greater improvements over PBO in RAPID3 scores and greater improvements over ADA from week 16 to week 56.
“The majority of patients achieved MCID in RAPID3 after 12 weeks of UPA or ADA, with higher proportions achieving MCID on UPA vs ADA by week 24,” the authors concluded. “RAPID3 was strongly associated with other joint-focused or multiple manifestation composite measures, further supporting the utility of RAPID3 in assessing disease activity in PsA.”
—Yvette C. Terrie
Coates L, Kavanaugh A, McDearmon-Blondell E, Mandelin A, Gao T, Tillett W. Upadacitinib versus adalimumab on routine assessment of patient index data 3 (RAPID3) in patients with psoriatic arthritis. Paper presented at: American College of Rheumatology Convergence 2022; November 10-24, 2022; Philadelphia, PA. Accessed November 14, 2022. https://acrabstracts.org/abstract/upadacitinib-versus-adalimumab-on-routine-assessment-of-patient-index-data-3-rapid3-in-patients-with-psoriatic-arthritis/