Switching to upadacitinib superior to cycling TNF inhibitors in rheumatoid arthritis
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Key takeaways:
- Switching from a TNF inhibitor to upadacitinib was superior to cycling TNF inhibitors.
- Upadacitinib outcomes were also better than other mechanisms of action.
Switching from a TNF inhibitor to upadacitinib leads to significantly better outcomes in rheumatoid arthritis vs. cycling TNF inhibitors or switching to another mechanism of action, according to data published in Advances in Therapy.
Specifically, patients who switched to upadacitinib (Rinvoq, Abbvie) demonstrated superior chances of remission, no pain and complete adherence to therapy, compared with those who cycled or moved on to another mechanism.
“Tumor necrosis factor inhibitors (TNFis) are often the first choice of targeted therapy for RA; however, many patients do not achieve treatment targets, such as sustained remission or low disease activity,” Roberto F. Caporali, MD, PhD, of the department of clinical sciences and community health at the University of Milan, in Italy, and colleagues wrote. “Approximately 30-40% of patients with RA discontinue treatment with TNFis due to primary failure, secondary loss of response, or intolerance.
“A prior meta-analysis and an economic evaluation demonstrated that switching to an advanced therapy (AT) with a different [mechanism of action (MOA)] may be more effective and less expensive than cycling through TNFis in patients with RA,” they added. “Upadacitinib, a Janus kinase inhibitor, has been recently approved for treatment of RA and there is, therefore, a paucity of real-world data surrounding its use and effectiveness.”
To compare the effectiveness of various switching therapies in RA, Caporali and colleagues analyzed data from the Adelphi RA Disease Specific Program, a cross-sectional, multinational survey of rheumatologists and their patients. The study included patients aged older than 18 years who were diagnosed with RA and were receiving a second line of advanced therapy for at least 6 months at the point of data collection.
Outcomes included physician-reported pain, fatigue, treatment adherence and disease activity, which were recorded at the initiation of current treatment and at 6 months or later from switching. The results of switching from a TNF inhibitor to upadacitinib vs. another TNF inhibitor — as well as switching to upadacitinib vs. another mechanism of action — were compared using inverse-probability-weighted regression adjustment. The “other mechanism of action” category included interleukin-6 inhibitors, CD20 inhibitors and CTLA-4 co-stimulators.
Overall, 503 patients received first-line TNF inhibitors, of whom 261 switched to upadacitinib, while 128 switched to another TNF inhibitor and 114 switched to another mechanism of action.
Compared with those who switched to another TNF inhibitor, patients who switched to upadacitinib demonstrated a significantly higher chance of achieving remission (67.7% vs. 40.3%; P = .0015), no pain (55.7% vs. 25.4%; P = .0007) and complete adherence (60% vs. 34.2%; P = .0049), according to the researchers.
Additionally, those who switched to upadacitinib saw similar improvements over those switching to another mechanism of action, including higher remission rates (69% vs. 44%, P = .008), as well as a better chance of no pain (57.7% vs. 20.9%, P < .001) and complete adherence (61.1% vs. 32.7%, P = .003) at follow-up.
“The findings of this real-world study of patients with RA demonstrate that switching from TNFi to [upadacitinib] versus TNFi to another TNFi or to an AT with another MOA was associated with greater proportions of patients achieving remission, having no pain, and achieving complete medication adherence, as reported by physicians,” Caporali and colleagues wrote. “Therefore, the results illustrate that UPA can improve disease management and alleviate disease-related symptoms in patients with RA.”
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