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Strand V, Mease PJ, Soriano ER, Kishimoto M, Salvarani C, Saffore CD, Zueger P, McDearmon-Blondell E, Kato K, Gladman DD. Improvement in Patient-Reported Outcomes in Patients with Psoriatic Arthritis Treated with Upadacitinib Versus Placebo or Adalimumab: Results from SELECT-PsA 1. Rheumatol Ther 2021; 8:1789-1808. [PMID: 34636026 PMCID: PMC8572257 DOI: 10.1007/s40744-021-00379-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/22/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The aim of this work is to assess the effect of upadacitinib versus adalimumab and placebo on patient-reported outcomes (PROs) in psoriatic arthritis (PsA) patients with inadequate responses to ≥ 1 non-biologic disease-modifying anti-rheumatic drugs (non-bDMARD-IR) in SELECT PsA-1. METHODS In this placebo- and active comparator, phase 3 randomized, controlled trial, patients received daily upadacitinib 15 or 30 mg, placebo, or adalimumab 40 mg every other week through 56 weeks. At week 24, placebo-assigned patients were rerandomized to upadacitinib 15 or 30 mg. PROs included Patient Global Assessment of Disease Activity (PtGA), pain, Health Assessment Questionnaire Disability Index (HAQ-DI), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Short Form 36 Health Survey (SF-36), EQ-5D-5L index score, Bath Ankylosing Spondylitis Disease Activity Index, morning stiffness, Self-Assessment of Psoriasis Symptoms, and Work Productivity and Activity Impairment. Mean changes from baseline in PROs, improvements ≥ minimum clinically important differences (MCID), scores ≥ normative values, and sustained clinically meaningful responses were compared between treatment groups. RESULTS At weeks 12 and 24, upadacitinib treatment resulted in improvements from baseline versus placebo across all PROs as well as improvements versus adalimumab in HAQ-DI and SF-36 Physical Component Summary score (nominal p < 0.05). Improvements in PtGA, pain, and HAQ-DI were reported as early as week 2. At week 12, significantly (nominal p < 0.05) more upadacitinib- versus placebo-treated patients reported improvements ≥ MCID across all PROs including seven SF-36 domains. The proportions of upadacitinib-treated patients reporting clinically meaningful improvements at week 12 were similar to or greater than with adalimumab and sustained through week 56. Significantly (nominal p < 0.05) more upadacitinib-treated (both doses) patients reported scores ≥ normative values at week 12 versus placebo, and scores were generally similar to or greater than adalimumab. CONCLUSIONS Upadacitinib treatment provides rapid, sustained, and clinically meaningful improvements in PROs in non-bDMARD-IR patients with PsA. SELECT-PsA 1 ClinicalTrials.gov number, NCT03104400.
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Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Philip J Mease
- Department of Rheumatology, Swedish Medical Center, Providence St Joseph Health and University of Washington, Seattle, WA, USA
| | - Enrique R Soriano
- Department of Public Health, Rheumatology Unit, Internal Medicine Services, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Carlo Salvarani
- Rheumatology Units, University of Modena and Reggio Emilia, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Christopher D Saffore
- Health Economics and Outcomes Research, AbbVie Inc., 1 N Waukegan Road, Dept. ABV1-4NW-105-03, North Chicago, IL, 60064-6078, USA.
| | - Patrick Zueger
- Health Economics and Outcomes Research, AbbVie Inc., 1 N Waukegan Road, Dept. ABV1-4NW-105-03, North Chicago, IL, 60064-6078, USA
| | - Erin McDearmon-Blondell
- Health Economics and Outcomes Research, AbbVie Inc., 1 N Waukegan Road, Dept. ABV1-4NW-105-03, North Chicago, IL, 60064-6078, USA
| | - Koji Kato
- Health Economics and Outcomes Research, AbbVie Inc., 1 N Waukegan Road, Dept. ABV1-4NW-105-03, North Chicago, IL, 60064-6078, USA
| | - Dafna D Gladman
- Department of Medicine, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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McInnes IB, Anderson JK, Magrey M, Merola JF, Liu Y, Kishimoto M, Jeka S, Pacheco-Tena C, Wang X, Chen L, Zueger P, Liu J, Pangan AL, Behrens F. Trial of Upadacitinib and Adalimumab for Psoriatic Arthritis. N Engl J Med 2021; 384:1227-1239. [PMID: 33789011 DOI: 10.1056/nejmoa2022516] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Janus kinase inhibitor upadacitinib is a potential treatment for psoriatic arthritis. The efficacy and safety of upadacitinib as compared with adalimumab, a tumor necrosis factor α inhibitor, in patients who have an inadequate response to nonbiologic disease-modifying antirheumatic drugs are unclear. METHODS In a 24-week, phase 3 trial, we randomly assigned patients in a 1:1:1:1 ratio to receive oral upadacitinib at a dose of 15 mg or 30 mg once daily, placebo, or subcutaneous adalimumab (40 mg every other week). The primary end point was an American College of Rheumatology 20 (ACR20) response (≥20% decrease in the number of tender and swollen joints and ≥20% improvement in at least three of five other domains) at week 12 with upadacitinib as compared with placebo. Secondary end points included comparisons of upadacitinib with adalimumab. RESULTS A total of 1704 patients received an active drug or placebo. The percentage of patients who had an ACR20 response at week 12 was 70.6% with 15-mg upadacitinib, 78.5% with 30-mg upadacitinib, 36.2% with placebo (P<0.001 for both upadacitinib doses vs. placebo), and 65.0% with adalimumab. The difference between groups for 15-mg upadacitinib as compared with adalimumab was 5.6 percentage points (95% confidence interval [CI], -0.6 to 11.8) and for 30-mg upadacitinib as compared with adalimumab was 13.5 percentage points (95% CI, 7.5 to 19.4). Both upadacitinib doses were noninferior to adalimumab for the ACR20 response at week 12; the 30-mg dose but not the 15-mg dose was superior to adalimumab. The incidence of adverse events through week 24 was 66.9% with 15-mg upadacitinib, 72.3% with 30-mg upadacitinib, 59.6% with placebo, and 64.8% with adalimumab. There were serious infections in 1.2%, 2.6%, 0.9%, and 0.7% of the patients, respectively. Hepatic disorders occurred in 9.1% of patients in the 15-mg upadacitinib group and 12.3% in the 30-mg upadacitinib group, but grade 3 increases in aminotransferase levels occurred in 2% of patients or fewer in all groups. CONCLUSIONS The percentage of patients with psoriatic arthritis who had an ACR20 response at week 12 was significantly higher with 15-mg or 30-mg upadacitinib than with placebo. The 30-mg dose but not the 15-mg dose was superior to adalimumab. Adverse events were more frequent with upadacitinib than with placebo. (Funded by AbbVie; SELECT-PsA 1 ClinicalTrials.gov number, NCT03104400.).
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Affiliation(s)
- Iain B McInnes
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
| | - Jaclyn K Anderson
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
| | - Marina Magrey
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
| | - Joseph F Merola
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
| | - Yi Liu
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
| | - Mitsumasa Kishimoto
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
| | - Slawomir Jeka
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
| | - Cesar Pacheco-Tena
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
| | - Xin Wang
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
| | - Liang Chen
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
| | - Patrick Zueger
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
| | - John Liu
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
| | - Aileen L Pangan
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
| | - Frank Behrens
- From the College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (I.B.M.); AbbVie, North Chicago, IL (J.K.A., X.W., L.C., P.Z., J.L., A.L.P.); Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland (M.M.); Brigham and Women's Hospital and Harvard Medical School, Boston (J.F.M.); the Department of Rheumatology, West China Hospital, Sichuan University, Chengdu, China (Y.L.); the Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo (M.K.); the Department of Rheumatology and Connective Tissue Diseases, Collegium Medicum Uniwersytet Mikołaja Kopernika, 2nd University Hospital, Bydgoszcz, Poland (S.J.); Facultad de Medicina, Universidad Autonoma de Chihuahua, Chihuahua, Mexico (C.P.-T.); and Goethe University and Fraunhofer Institute for Molecular Biology and Applied Ecology-Branch for Translational Medicine and Pharmacology and Cluster of Excellence for Immune-Mediated Diseases, Frankfurt, Germany (F.B.)
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Mease PJ, Lertratanakul A, Anderson JK, Papp K, Van den Bosch F, Tsuji S, Dokoupilova E, Keiserman M, Wang X, Zhong S, McCaskill RM, Zueger P, Pangan AL, Tillett W. Upadacitinib for psoriatic arthritis refractory to biologics: SELECT-PsA 2. Ann Rheum Dis 2020; 80:312-320. [PMID: 33272960 PMCID: PMC7892371 DOI: 10.1136/annrheumdis-2020-218870] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Upadacitinib is a Janus kinase inhibitor under evaluation for the treatment of psoriatic arthritis (PsA). We evaluated upadacitinib in patients with PsA and prior inadequate response or intolerance to at least one biologic disease-modifying antirheumatic drug (DMARD). METHODS In this 24-week randomised, placebo-controlled, double-blind, phase 3 trial, 642 patients were randomised (2:2:1:1) to once per day upadacitinib 15 mg or 30 mg, placebo followed by upadacitinib 15 mg or placebo followed by upadacitinib 30 mg at week 24. The primary endpoint was the proportion of patients achieving American College of Rheumatology (ACR) 20 response at week 12. Achievement of minimal disease activity (MDA) was assessed at week 24. Treatment-emergent adverse events are reported for all patients who received at least one dose of trial drug. RESULTS At week 12, significantly more patients receiving upadacitinib 15 mg and 30 mg versus placebo achieved ACR20 (56.9% and 63.8% vs 24.1%; p<0.001 for both comparisons). At week 24, MDA was achieved by more upadacitinib 15 mg-treated (25.1%) and 30 mg-treated patients (28.9%) versus placebo (2.8%; p<0.001 for both comparisons). Generally, the rates of treatment-emergent adverse events were similar with placebo and upadacitinib 15 mg and higher with upadacitinib 30 mg at week 24. Rates of serious infections were 0.5%, 0.5% and 2.8% with placebo, upadacitinib 15 mg and upadacitinib 30 mg, respectively. CONCLUSION In this trial of patients with active PsA who had inadequate response or intolerance to at least one biologic DMARD, upadacitinib 15 mg and 30 mg was more effective than placebo over 24 weeks in improving signs and symptoms of PsA. CLINICAL TRIAL REGISTRATION NUMBER NCT03104374.
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Affiliation(s)
- Philip J Mease
- Rheumatology, Swedish Medical Center, Seattle, Washington, USA .,School of Medicine, University of Washington, Seattle, Washington, USA
| | | | | | - Kim Papp
- Probity Medical Research and K Papp Clinical Research Inc, Waterloo, Ontario, Canada
| | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University, VIB Center for Inflammation Research, Ghent, Belgium, Gent, Belgium
| | - Shigeyoshi Tsuji
- Department of Orthopaedics/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Kawachi-Nagano, Japan
| | - Eva Dokoupilova
- Medical Plus, Uherske Hradiste, Czech Republic.,Department of Pharmaceutics, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Jihomoravský, Czech Republic
| | - Mauro Keiserman
- Rheumatology Section, Pontifical Catholic University, School of Medicine, Porto Alegre, Brazil
| | - Xin Wang
- AbbVie Inc, North Chicago, Illinois, USA
| | | | | | | | | | - William Tillett
- Department of Rheumatology, Royal National Hospital for Rheumatic Disease, Bath, UK.,Department of Pharmacy and Pharmacology, Centre for Therapeutic Innovation and Institute for Mathematical Innovation, University of Bath, Bath, UK
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