Effectiveness of Upadacitinib Versus Other Advanced Therapies in Rheumatoid Arthritis After Tumor Necrosis Factor Inhibitor Use in the United States

Understanding comparative effectiveness of different biologic therapies in patients with inadequate response to a prior tumor necrosis factor inhibitor (TNFi) may guide treatment decisions. This real-world analysis compared the clinical effectiveness of upadacitinib versus other advanced treatments (ATs), including TNFi, interleukin (IL)-6 inhibitors, and T cell co-stimulation modulators, in patients with rheumatoid arthritis (RA) who previously received a TNFi. This retrospective cohort study used data from the OM1 ® RA Registry (OM1, Inc.; Boston, MA, USA). Patients with RA (≥ 18 years) treated with upadacitinib or other ATs who previously received a TNFi and had high disease activity (Clinical Disease Activity Index [CDAI] > 22) and both a tender joint count and swollen joint count of ≥ 6 at baseline were included. The outcome of interest was achievement of CDAI low disease activity (LDA)/remission at 12 months. Descriptive statistics were reported for proportion of patients who achieved CDAI LDA/remission at 12 months. Multivariable analyses using generalized estimating equation compared CDAI LDA/remission rates for upadacitinib versus IL-6 inhibitors, T cell co-stimulation modulator, and TNFi. A total of 378 patients were included in the analysis: upadacitinib ( N = 73), IL-6 inhibitors ( N = 64), T cell co-stimulation modulator ( N = 76), or a different TNFi ( N = 165). Descriptive statistics showed a greater proportion of patients receiving upadacitinib achieved CDAI LDA/remission at 12 months (43.8%) versus IL-6 inhibitors (23.4%), T cell co-stimulation modulator (30.3%), or TNFi (31.5%). Multivariable analyses showed that patients receiving other ATs including IL-6 inhibitors (odds ratio, OR [95% confidence interval] 0.35 [0.16, 0.76], p = 0.01), T cell co-stimulation modulator (OR 0.46 [0.22, 0.95], p = 0.04), or TNFi (OR 0.52 [0.29, 0.96], p = 0.04) had lower odds of achieving CDAI remission/LDA compared to those receiving upadacitinib. In this real-world analysis of patients with RA who previously received TNFis and had high disease burden, more patients treated with upadacitinib achieved CDAI LDA/remission at 12 months versus other ATs.