Long-term Efficacy and Safety of Upadacitinib in Patients With Psoriatic Arthritis Refractory to Biologic Therapies: 2-Year Results From the Phase 3 SELECT-PsA 2 Study
Main Author: Philip J. Mease
Chicago, United States of America
¹Philip J Mease, ²Erin Mcdearmon-Blondell, ²Arathi Setty, ³Kim Papp, ⁴Filip Van den Bosch, ⁵Shigeyoshi Tsuji, ⁶Mauro Keiserman, ²Xianwei Bu, ²Liang Chen, ⁷William Tillett
¹Swedish Medical Center; Providence St. Joseph Health And University Of Washington, ²Abbvie Inc, North Chicago, Usa;, ³Papp Clinical Research and Probity Medical Research, Dermatology, Waterloo, Canada;, ⁴Ghent University, VIB Center for Inflammation Research, Internal Medicine and Pediatrics, ⁵National Hospital Organization; Osaka Minami Medical Center, ⁶Pontifical Catholic University, School of Medicine, Porto Alegre, Brazil;, ⁷Royal National Hospital For Rheumatic Diseases, Rheumatology, Bath, United Kingdom
Upadacitinib (UPA), an oral Janus kinase (JAK) inhibitor, demonstrated efficacy and safety in patients (pts) with psoriatic arthritis (PsA) and prior inadequate response or intolerance to ≥1 biologic disease-modifying antirheumatic drug (bDMARD) at week (wk) 56 in the phase 3 SELECT-PsA 2 study.
Objectives: To evaluate the efficacy and safety of UPA at wk 104 from the ongoing long-term extension of SELECT-PsA 2
Method(s): Pts were randomized to UPA 15 mg (UPA15), UPA 30 mg (UPA30), or placebo (PBO) for 24 wks; PBO pts were then switched to UPA15 or UPA30. For continuous UPA treatment groups, efficacy endpoints at wk 104 were analyzed using non-responder imputation (NRI) and as observed (AO) (binary endpoints) or mixed-effect model repeated measures (MMRM) and AO (continuous endpoints). Treatment-emergent adverse events (TEAEs) were summarized for pts who received ≥1 dose of study drug using visit-based cut-off at wk 104.
A total of 641 pts received ≥1 dose of study drug. At wk 104, 38.4% of all patients had discontinued study drug, with the highest discontinuation observed in patients randomized to PBO at baseline (all PBO: 46.7%). The most common reasons for discontinuation were lack of efficacy (UPA15: 12.3%, UPA30: 8.7%, all PBO: 21.7%) and adverse event (UPA15: 10.9%, UPA30: 13.3%, all PBO: 12.7%).
The proportion of UPA pts that achieved ACR20/50/70, MDA, PASI75/90/100, and resolution of dactylitis and enthesitis were generally similar, or further improved, with 104 wks of treatment vs 56 wks1 (Table). Similarly, mean change from baseline in HAQ-DI, patient’s assessment of pain, BASDAI, and ASDAS was improved with UPA treatment. At 104 wks of therapy, clinical responses were largely similar with UPA15 and UPA30. Generally, safety data at wk 104 (Figure) were consistent with that reported at wk 56.1 Rates of serious infection, herpes zoster, hepatic disorder, anemia, neutropenia, lymphopenia, and CPK elevation remained numerically higher with UPA30 vs UPA15, while rates of malignancies, MACE, and VTE were similar for both UPA groups. One death was reported with UPA15 (unexplained due to lack of information; however, the patient had recently been diagnosed with ovarian cancer) and 2 with UPA30 (pancytopenia and COVID-19 pneumonia).
In PsA pts with prior inadequate response or intolerance to ≥1 bDMARD, clinical responses were maintained with UPA15 and UPA30 up to 2 years of treatment. No new safety signals were identified in this long-term extension.