Upadacitinib Shows Sustained Responses in PsA After Prior TNF Inhibitor: Analysis
Key Takeaways
- Upadacitinib 15 mg once daily was associated with higher ACR20/50/70 and minimal disease activity response rates than placebo at week 24 among patients with psoriatic arthritis (PsA) previously exposed to 1 TNF inhibitor (TNFi), a new analysis suggests.
- Clinical responses were maintained or improved through 152 weeks; efficacy was similar regardless of duration of prior TNFi exposure.
- Early reductions in pain predicted minimal disease activity at week 152.
- Investigators reported no new safety signals.
A post hoc analysis of SELECT-PsA 2 found sustained responses with upadacitinib 15 mg once daily through 152 weeks among patients with psoriatic arthritis (PsA) previously exposed to 1 tumor necrosis factor inhibitor (TNFi).
Published in RMD Open, the analysis included 195 patients with exposure to 1 prior TNFi. Investigators evaluated long-term efficacy and safety as well as whether duration of previous TNFi exposure, early pain response, and anatomic location of psoriasis affected outcomes.
Upadacitinib Shows Sustained Psoriatic Arthritis Responses Through Week 152
Patients were randomized to upadacitinib 15 mg once daily (n = 90) or placebo (n = 105), with patients receiving placebo switching to upadacitinib at week 24.
At week 24, 57.8% of patients randomized to upadacitinibACR20 responses were achieved by 57.8% of patients randomized to upadacitinib compared with 21.9% receiving placebo. ACR50 rates were 37.8% versus 9.5%, respectively, and ACR70 rates were 22.2% versus 0%. Minimal disease activity (MDA) was achieved by 24.4% and 2.9%, respectively.
Responses were maintained or improved through 152 weeks. Patients who switched from placebo to upadacitinib at week 24 also achieved sustained PASI75 and PASI90 responses across different anatomic regions. Efficacy was similar regardless of the duration of previous TNFi exposure in sensitivity.
Investigators reported no new safety signals.
“Upadacitinib 15 mg once daily demonstrated sustained efficacy and an acceptable safety profile in patients with PsA and exposure to one prior TNFi, irrespective of the duration of previous TNFi exposure,” the authors concluded.
Source
Coates L, et al. Rheumatology and Musculoskeletal Diseases (BMJ Open). 2026. Doi:10.1136/rmdopen-2025-006655