PO:02:025 | Real-World Comparative Effectiveness of Upadacitinib in Psoriatic Arthritis: Evaluation of Switching to Upadacitinib Versus Tumor Necrosis Factor Inhibitors or Interleukin-17 Inhibitors After First-Line Tumor Necrosis Factor Inhibitors

Valentina Carlini¹, Philip Mease², William Tillett³, Xiaolan Ye⁴, Christopher Saffore⁴, Molly Edwards⁵, Isabel Truman⁵, Sophie Barlow⁵, Jayne Stigler⁴, Bhumik Parikh⁴, Daniel Aletaha⁶ | ¹Abbvie srl Roma, Italy; ²University of Washington School of Medicine Seattle, United States Minor Outlying Islands; ³Department of Rheumatology, Royal National Hospital for Rheumatic Diseases Bath, United Kingdom; ⁴Abbvie Inc. North Chicago, United States Minor Outlying Islands; ⁵Adelphi Real World Bollington, United Kingdom; ⁶Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria

Purpose. There is mixed evidence that cycling to another TNFi after failure of a first-line TNFi is associated with lower response rates on joint symptoms in PsA. However, there are limited studies that investigate whether cycling to another TNFi or switching to a different mechanism of action is more favorable. Thus, the aim of this study was to compare the effectiveness of switching from a first-line TNFi to upadacitinib (UPA) versus cycling to another TNFi or switching from a TNFi to an IL-17 inhibitor (IL-17i) on tender and swollen joint involvement in patients with PsA.

Methods. Data were drawn from the Adelphi Real-World Spondylarthritis V/VI Disease-Specific Programmes™, cross-sectional surveys administered to physicians and their consulting patients in routine clinical practice in Germany, France, Italy, Spain, the United Kingdom, and the United States (SpA VI only), with respective data collection periods from March 2021 to November 2021 for SpA V and from June 2023 to June 2024 for SpA VI. Adult patients with PsA who switched treatment from a TNFi in the first line to another advanced therapy were stratified by the second-line therapy: TNFi to UPA, TNFi to TNFi, or TNFi to IL-17i. The key outcome of physician-reported assessment of both TJC<=1 and SJC<=1 was evaluated <=3 months from treatment switch. Patient demographics and clinical characteristics were balanced using inverse-probability-weighted regression adjustment (IPWRA). The covariates balanced within the IPWRA were age, sex, Charlson Comorbidity Index (CCI), and severity at initiation of second-line therapy as reported by their physician for the weighting and regression adjustment stage, and second-line treatment duration was used for the regression adjustment stage. The regression analyses were conducted separately for comparisons between TNFi to UPA and TNFi to TNFi as well as between TNFi to UPA and TNFi to IL-17i.

Results. Of the 320 patients included in the analysis who switched from a first-line TNFi, 101 switched to UPA, 96 switched to a second TNFi, and 123 switched to an IL-17i. Patient demographics are presented in Tab.1. The most frequent reason for switching reported by the physician was a worsening of the joints. After adjustment via IPWRA, significantly more patients in the TNFi to UPA group had physician-reported assessment of both TJC and SJC <= 1 at the time of data collection compared with patients in the TNFi to TNFi group (94%vs.76%; P=0.0342) and the TNFi to IL-17i group (91%vs.72%; P=0.0123, Fig.1).

Conclusions. Patients who switched from their first TNFi advanced therapy to UPA as their second-line advanced therapy had significantly lower levels of TJC and SJC than cycling to a second TNFi or switching to an IL-17i. The results demonstrate that switching to UPA after a TNFi may benefit patients with PsA. 1.Gossec L.2024;83(6):706-719. 2.Abramson SR.2016;1(3):102-111.