Abstract Background/Aims The aim of this study was to compare effectiveness of switching from a first-line TNF inhibitor (TNFi) to upadacitinib, an oral JAK inhibitor, versus cycling to another TNFi or switching to an IL-17 inhibitor (IL-17i) on tender and swollen joint involvement in patients with psoriatic arthritis (PsA). Methods Data were drawn from Adelphi Real World Spondylarthritis (SpA) V and VI Disease Specific Programmes™, cross-sectional surveys administered to physicians and their consulting patients in routine clinical practice in Germany, France, Italy, Spain, United Kingdom, and United States (SpA VI only), with data collection periods from March 2021 to November 2021 (SpA V) and from June 2023 to June 2024 (SpA VI). Adult patients with PsA who switched treatment from a TNFi in the first line of advanced therapy to another advanced therapy were stratified by second-line therapy: TNFi to upadacitinib, 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).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 additionally second-line treatment duration was used for the regression adjustment stage. Regression analyses were conducted separately for comparisons between TNFi to upadacitinib and TNFi to TNFi as well as between TNFi to upadacitinib and TNFi to IL-17i. Results Of 320 patients included in the analysis who switched from a first-line TNFi, 101 switched to upadacitinib , 96 switched to a second TNFi, and 123 switched to an IL-17i. The most used first-line TNFi in each group was adalimumab. The most used second-line therapy was adalimumab for the TNFi to TNFi group and secukinumab for the TNFi to IL-17i group. The most frequent reason for switching was a worsening of the joints. At the time of switch, most patients had a physician-reported assessment of moderate/severe disease severity (TNFi to upadacitinib: 92%; TNFi to TNFi: 89%; TNFi to IL-17i: 93%). After adjustment via IPWRA, significantly more patients in the TNFi to upadacitinib 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). Conclusion Patients who switched from their first TNFi advanced therapy to upadacitinib had significantly lower levels of tender and swollen joint involvement than patients cycling to a second TNFi or switching to an IL-17i. Results demonstrate that switching to upadacitinib after a TNFi may benefit patients with PsA. Disclosure P.J. Mease: Consultancies; Has received speakers fees from AbbVie, Acelyrin, Amgen, Bristol Myers, Inmagene, Janssen, Lilly, Moonlake, Novartis, Pfizer, and UCB. Honoraria; Has received consulting fees from AbbVie, Acelyrin, Amgen, Bristol Myers, Inmagene, Janssen, Lilly, Moonlake, Novartis, Pfizer, and UCB. Grants/research support; Has received research grants from AbbVie, Acelyrin, Amgen, Bristol Myers, Inmagene, Janssen, Lilly, Moonlake, Novartis, Pfizer, and UCB. W. Tillett: Consultancies; Has received consulting fees from AbbVie, Amgen, Celgene, Eli Lilly, GSK, Janssen, MSD, Novartis, Ono-Pharma, Pfizer, and UCB. Grants/research support; Has received research grants from AbbVie, Celgene, Eli Lilly, GSK, Janssen, Pfizer, and UCB. X. Ye: Corporate appointments; Is an employee of AbbVie. Shareholder/stock ownership; May hold AbbVie stock or stock options. C.D. Saffore: Corporate appointments; Is an employee of AbbVie. Shareholder/stock ownership; May hold AbbVie stock or stock options. M. Edwards: Corporate appointments; Is an employee of Adelphi Real World. Consultancies; Acted as a consultant to AbbVie for this analysis. I. Truman: Corporate appointments; Is an employee of Adelphi Real World. Consultancies; Acted as a consultant to AbbVie for this analysis. S. Barlow: Corporate appointments; Is an employee of Adelphi Real World. Consultancies; Acted as a consultant to AbbVie for this analysis. J. Stigler: Corporate appointments; Is an employee of AbbVie. Shareholder/stock ownership; May hold AbbVie stock or stock options. B. Parikh: Corporate appointments; Is an employee of AbbVie. Shareholder/stock ownership; May hold AbbVie stock or stock options. C. Hansell: Corporate appointments; Is an employee of AbbVie. Shareholder/stock ownership; May hold AbbVie stock or stock options. D. Aletaha: Consultancies; Janssen, AbbVie, Amgen, Celgene, Eli Lilly, Medac, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, Has received consulting fees from Janssen, AbbVie, Amgen, Celgene, Eli Lilly, Medac, Merck, Novartis, Pfizer, Roche, Sandoz, and Sanofi. Honoraria; Has received speakers fees from Bristol Myers Squibb, Merck Sharp Has received research grants from AbbVie, Merck Sharp & Dohme, Novartis, and Roche.
Mease et al. (Wed,) studied this question.