Ab0940 Upadacitinib in Axial Spondyloarthritis: Therapeutic Possibilities and Perspectives in Real World Clinical Practice

Background: Axial Spondyloarthritis (AxSpA) is a chronic inflammatory condition affecting the axial skeleton, accompanied by pain and restricted movement, resulting in the accumulation of cardiovascular diseases, early disability, and death. Upadacitinib, as a novel Janus kinase 1 (JAK1) inhibitor, seems to offer new therapeutic possibilities for patients with AxSpA, as indicated by clinical studies. Objectives: To assess the therapeutic effectiveness of upadacitinib in patients with AxSpA in real-world clinical practice and to identify predictors/risk factors influencing the therapeutic outcome. Methods: In a retrospective study, patients with AxSpA from the registry of University Hospital "St. Marina," Rheumatology Clinic, Varna, were included. The patients undergo treatment with 15 mg upadacitinib daily according to the criteria of the National Health Insurance Fund. The treatment commences after a precise diagnosis (ASAS criteria¹) and adherence to well-established recommendations. Clinical-demographic parameters (HLA-B27, conventional X-ray, and/or MRI of the sacroiliac joints, inflammation activity) were analyzed. The medical documentation for concomitant arterial hypertension (AH) was examined. The activity of AxSpA was assessed using ASDAS CRP and BASDAI, and patients were categorized based on widely accepted thresholds of composite assessments before and at the 6th month of upadacitinib treatment. The odds ratio between outcomes at six months and baseline clinical characteristics, as well as concomitant arterial hypertension was examined. Results: 42 patients with an average age of 53.1 years (±11.0) and a slight male predominance (57.1%, p>0.05) underwent a 6-month treatment with upadacitinib. In a significant portion of the patients, the diagnosis was established within the first 5 years of treatment initiation (73.8%, p=0.002), with an advanced (III/IV) x-ray stage of sacroiliitis observed in 85.7% of the patients (p<0.001). The distribution according to "biologic-naive" status was uniform in the group (45.42 vs. 54.8, p>0.05). Less than half of the patients had concomitant arterial hypertension (42.9%, p>0.05). At the sixth month of upadacitinib treatment, a significant number of patients achieved low disease activity, as indicated by both ASDAS and BASDAI (85.7% and 95.2%, respectively, p<0.001). Despite no significant differences being observed among patients in LDA at the 6th month of treatment based on the presence of AH (91.7% vs 77.8%, p>0.05) and disease duration (≤ 5 years or >5 years) (87.1% vs 81.8%, p>0.05), these two characteristics are identified as predictors of the likelihood of a therapeutic outcome. The likelihood in patients with AxSpA with a disease duration of ≤ 5 years, compared to those with >5 years, as well as in patients without AH compared to those with concomitant AH, shows a significantly higher probability of achieving LDA with ASDAS-CRP after 6 months of treatment with upadacitinib (OR = 3.5, 95% CI 1.1-11.1, and respectively 5.3, 1.1-25.3). Conclusion: In real-world clinical practice, low disease activity is observed in a significant number of patients with axial spondyloarthritis (AxSpA) after six months of treatment with Upadacitinib. The shorter disease duration, i.e., less than 5 years, and the absence of arterial hypertension are associated with a higher likelihood of a favorable therapeutic response. These results emphasize the complexity of factors influencing outcomes in the treatment of axial spondyloarthritis and highlight the need for more detailed studies in a real-world clinical environment. REFERENCES: [1] Akgul O, Ozgocmen S. Classification criteria for spondyloarthropathies. World J Orthop. 2011 Dec 18;2(12):107-15. doi: 10.5312/wjo.v2.i12.07. PMID: 22474629; PMCID: PMC3302034. Acknowledgements: I want to express sincere gratitude to my colleagues in the field of rheumatology for their valuable insights and collaborative efforts. Special thanks to the management of Medical University- Prof. Dr. P. Stoyanov, Varna, and UMBAL "St. Marina"-Varna for their trust and support. This study became possible thanks to the joint efforts of all my colleagues from the Rheumatology Clinic in Varna, including dedicated individuals dedicated to the development of rheumatological science and practice. I express my gratitude to each of them for their contribution and collective spirit. Together, we strive to create a comprehensive and impactful scientific study to meet the needs of real-world clinical practice. Disclosure of Interests: None declared.