Upadacitinib beneficial in PsA patients with axial involvement
medwireNews: A pooled analysis of data from the SELECT-PsA-1 and SELECT-PsA-2 trials suggests that treatment with the Janus kinase (JAK) inhibitor upadacitinib improves axial symptoms in patients with psoriatic spondylitis.
“Although there is no evidence-based definition of psoriatic spondylitis, affected patients display greater disease activity and impaired quality of life compared with those without axial involvement,” said Atul Deodhar (Oregon Health & Science University, Portland, USA) at the EULAR 2021 Virtual Congress.
He reported that 31% of 1704 patients in SELECT-PsA-1 and 34% of 640 in SELECT-PsA-2 had axial involvement at baseline, and these people had significantly higher tender joint counts, duration of morning stiffness, and rates of enthesitis and dactylitis than those without axial involvement.
When data from patients with axial involvement were pooled from both trials, those treated with upadacitinib 15 mg or 30 mg once daily experienced significantly greater improvements from baseline in average BASDAI score than those given placebo, at both 12 weeks (1.75 and 2.22 vs 0.56 points, respectively) and 24 weeks (2.61 and 2.71 vs 1.00 points).
Deodhar noted that a similar pattern of results was seen when axial disease activity was measured using a modified BASDAI score that omitted the question on peripheral joint pain and swelling, “suggesting that observed improvements in overall BASDAI were not driven by efficacy in peripheral arthritis.”
Patients treated with either dose of upadacitinib also experienced significantly greater improvements in ASDAS than those given placebo, and those in the JAK inhibitor groups were significantly more likely to achieve ASDAS inactive disease (<1.3 points) or low disease activity (<2.1 points).
Therefore, the JAK inhibitor is “efficacious in improving axial symptoms in patients with psoriatic arthritis [PsA], consistent with results observed in ankylosing spondylitis patients,” said Deodhar.
He said that “few events of new or recurrent extra-articular manifestations” were reported in the pooled analysis. One patient treated with upadacitinib 30 mg developed new-onset uveitis, and there were two cases of uveitis in the placebo group (one new-onset and one flare). There were no cases of inflammatory bowel disease among upadacitinib-treated patients.
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