The following article is a part of conference coverage from the American College of Rheumatology Convergence 2020, being held virtually from November 5 to 9, 2020. The team at Rheumatology Advisor will be reporting on the latest news and research conducted by leading experts in rheumatology. Check back for more from the ACR Convergence 2020.
Treatment with upadacitinib was found to have rapid, significant, and clinically meaningful reductions in pain in adults with active psoriatic arthritis (PsA) with an inadequate response to nonbiologic or biologic disease-modifying antirheumatic drugs (DMARDs), according to study results presented at the presented at the American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020.
Previous studies have supported the efficacy and safety of upadacitinib in patients with active PsA. The current analysis aimed at determining the efficacy of upadacitinib compared with placebo and adalimumab on pain through 24 weeks in patients with active PsA.
The SELECT-PsA program included adults with active PsA with prior inadequate response or intolerance to 1 or more nonbiologic (SELECT-PsA 1; ClinicalTrials.gov Identifier: NCT03104400) or biologic (SELECT-PsA 2; ClinicalTrials.gov Identifier: NCT03104374) DMARDs. Participants were randomly assigned to receive upadacitinib 15 mg or 30 mg once daily, or placebo (both SELECT-PsA 1 and SELECT-PsA 2) or adalimumab 40 mg every other week (SELECT-PsA 1).
Pain was assessed as percentage of patients achieving 30% or more, 50% or more, or 70% or more reduction from baseline in patient’s global assessment of pain numeric rating scale (NRS) score; minimal clinically important difference in pain (defined ≥1 point or 15% reduction from baseline on a 0-10 NRS); and change from baseline in pain NRS at all timepoints. In addition, the researchers assessed changes from baseline in spinal pain and joint pain/swelling, according to Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and bodily pain and pain interference, according to the 36-Item Short Form Survey (SF-36).
In both studies, a higher percentage of patients receiving upadacitinib vs placebo showed improvements in most pain end points at 2 weeks, and these improvements were sustained or increased through the 24-week follow-up (P <.05). Upadacitinib vs placebo was associated with a significant change from baseline in patient’s global assessment of pain NRS scores over time, BASDAI spinal pain and joint pain/swelling, and SF-36 bodily pain and pain interference at weeks 12 and 24.
In the SELECT-PsA 1 study, a significantly higher percentage of patients receiving upadacitinib 30 mg daily vs adalimumab 40 mg every other week achieved improvements in most pain scores at 2 weeks, which were sustained through week 24. Compared with adalimumab 40 mg every other week, upadacitinib 15 mg once daily was also associated with significantly greater improvements in several pain assessments (P <.05).
“In [patients] with active PsA who had inadequate response to nonbiologic or biologic DMARDs, a greater [percentage] of [patients] treated with [upadacitinib] vs [placebo] achieved rapid, significant, and clinically meaningful reductions in pain across multiple pain assessments,” the study authors concluded.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
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McInnes I, Tillett W, Mease P, et al. Impact of upadacitinib on reducing pain in patients with active psoriatic arthritis: results from two phase 3 trials in patients with inadequate response to non-biologic or biologic DMARDs. Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 0896.