Effects of upadacitinib or adalimumab on pain in rheumatoid arthritis and psoriatic arthritis: results from randomised phase 3 studies.

INTRODUCTION

Patients with rheumatoid (RA) or psoriatic (PsA) arthritis can experience debilitating pain.

METHODS

Post hoc analyses of phase 3, double-blind studies in patients with active disease despite treatment (SELECT-COMPARE, SELECT-PsA 1) assessed the effects of upadacitinib or adalimumab versus placebo on pain in patients with attenuation of inflammation (AoI) versus remaining inflammation at weeks 12 and 24/26 (PsA/RA). Further, a mediation analysis assessed the direct/indirect effect of treatment on pain using the Patient's Global Assessment of pain (PtGA) and 28 tender joint count (TJC28) at weeks 2/12/26 in RA, and weeks 16/24 in PsA.

RESULTS

In patients with RA+AoI, PtGA scores improved more with upadacitinib (least squares mean change, -42.9) versus adalimumab (-34.7 (p<0.05)) or placebo (-33.1 (p<0.05)) at week 12 from baseline; improvements were similar across groups by week 26. For PsA+AoI, improvement was greater with upadacitinib (week 12, -2.7; week 24, -3.8) versus placebo (-1.8 (p<0.05); -2.8 (p<0.001), respectively) and similar to adalimumab (-2.8, -3.6). For RA, the direct effect on pain was nearly two times greater with upadacitinib versus placebo compared with adalimumab at weeks 12/26. For PsA, total effects on pain (TJC28 improvement) at weeks 16/24 were greater with upadacitinib (2.16 and 2.30) and adalimumab (1.35 and 1.71) versus placebo.

CONCLUSIONS

Upadacitinib effectively reduced pain in active RA and PsA, including in patients with AoI. The greater pain relief observed in RA with upadacitinib versus adalimumab might indicate both direct (relieving non-inflammatory pain) and indirect (suppressing inflammation) effects.