Upadacitinib shows greater improvement in PsA compared with adalimumab, placebo
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PHILADELPHIA — In patients with psoriatic arthritis, upadacitinib showed greater improvement compared with both placebo and adalimumab as assessed by the Routine Assessment of Patient Index Data 3, or RAPID3, scores.
The results were presented in a poster presentation at ACR Convergence 2022.
According to the poster, the study aimed to evaluate both the long-term effect of upadacitinib (Rinvoq, AbbVie) compared with adalimumab (Humira, AbbVie) through 56 weeks using RAPID3 scores in patients with PsA, and how RAPID3 correlates with other clinical composite disease activity measures used in PsA.
“RAPID3 is a fast and convenient tool that can be used in clinical practice to assess disease activity,” Laura Coates, MD, PhD, associate professor and National Institute for Health Research clinician scientist at the Nuffield department of orthopedics, rheumatology and musculoskeletal sciences at the University of Oxford in the UK, said in her presentation. “It’s been shown to be applicable in multiple rheumatic diseases, including psoriatic arthritis.”
The analysis included data from SELECT-PsA 1, a double blind trial that included patients with PsA and an inadequate response or intolerance to one or more non-biologic disease-modifying antirheumatic drug who received 15 mg or 30 mg of upadacitinib once daily, 40 mg of adalimumab every other week, or placebo. RAPID3 endpoints were calculated from pain scores, patient’s global assessment of disease activity, and HAQ-DI, and scores ranged from 0, no disease activity, to 30, severe disease activity.
The final analysis included 1274 patients, of which 421 were in the placebo arm, 425 in the upadacitinib arm, and 428 in the adalimumab arm. Coates and colleagues reported comparable RAPID3 scores at baseline across all treatment arms, with most patients experiencing high disease activity. From 16 weeks to 56 weeks follow up, patients in the upadacitinib arm demonstrated a greater improvement from baseline in RAPID3 compared with patients in the adalimumab arm. When compared with placebo at all assessments, the upadacitinib arm also showed greater improvement, according to the poster.
From week 24 to week 56, a greater portion of patients in the upadacitinib arm achieved minimal clinically important differences (MCID) in RAPID3 scores compared with patients in the adalimumab arm. When all treatment arms were pooled together, RAPID3 disease categories were strongly associated with disease activity in PsA and minimal disease activity/very low disease activity status at week. This same association was also seen for the upadacitinib arm.
“RAPID3 was strongly associated with other composite measures, suggesting that this tool can serve as a useful, convenient measure of disease activity in clinical practice,” Coates said.
Finally, at week 56, 30% of patients were in remission and 22% demonstrated low disease activity in the upadacitinib arm, while 28% were in remission and 17% had low disease activity in the adalimumab arm, according to the poster.
“This post hoc analysis demonstrates that upadacitinib treatment resulted in greater improvements in RAPID3 and higher proportions of patients achieving MCID compared to adalimumab by week 24,” Coates concluded.
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Coates L, et al. Abstract 0192. Presented at: ACR Convergence 2022; November 11-14, 2022; Philadelphia (hybrid meeting).
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