A Real-World Comparison of Clinical Effectiveness of Upadacitinib, Tumor Necrosis Factor Inhibitors or Interleukin-17 Inhibitors in Patients with Axial Spondyloarthritis After Switching from an Initial Tumor Necrosis Factor Inhibitor Treatment.

INTRODUCTION

Tumor necrosis factor inhibitors (TNFi) may have insufficient efficacy in 40% of patients with axial spondyloarthritis (axSpA), leading to continued pain. We aimed to compare real-world effectiveness of switching from an initial TNFi to upadacitinib (TNFi-UPA), another TNFi (TNFi-TNFi), or an interleukin-17 inhibitor (TNFi-IL-17i) in patients with axSpA.

METHODS

Data were drawn from the Adelphi Real World Spondyloarthritis Disease Specific Programme™, a cross-sectional survey of physicians and their patients with axSpA in France, Germany, Italy, Spain, the UK, and the USA from March-November 2021 and June 2023-June 2024. Patients who switched treatment from an initial TNFi were stratified by subsequent therapy: TNFi-UPA, TNFi-TNFi, or TNFi-IL-17i. Physician-reported clinical outcomes including pain (rated 0-10) and number of joints affected by inflammation or stiffness (from 0 to 68) were evaluated ≥ 3 months from treatment switch. Differences in characteristics were adjusted at the point of switch via inverse-probability-weighted regression adjustment to compare outcomes in separate analyses by subsequent class of therapy: TNFi-UPA versus TNFi-TNFi or TNFi-UPA versus TNFi-IL-17i.

RESULTS

Overall, 310 physicians provided data for 557 patients; 108 were TNFi-UPA, 271 TNFi-TNFi, and 178 TNFi-IL-17i. A higher proportion of patients in the TNFi-UPA group achieved a ≥ 2 point and ≥ 33% reduction in pain than those in the TNFi-IL-17i (97.6% vs 86.4%; p = 0.002) or TNFi-TNFi (100.0% vs 80.1%; p < 0.001) groups. More patients achieved ≥ 50% reduction in pain in the TNFi-UPA group compared to TNFi-IL-17i (90.9% vs 74.0%; p = 0.004) or TNFi-TNFi (96.3% vs 72.3%; p = 0.024). More patients in the TNFi-UPA group had no affected joints than TNFi-IL-17i (93.1% vs 72.6%; p = 0.002) or TNFi-TNFi patients (100.0% vs 79.2%; p < 0.001).

CONCLUSION

This real-world study demonstrated that more patients who switched from TNFi to UPA had improvements in pain and affected joints compared to those who switched to a second TNFi or IL-17i.