Treatment with Upadacitinib in Difficult-to-Treat (D2T) Psoriatic Arthritis (PsA): A National Multicenter Study of the First 134 Patients in Clinical Practice

Upadacitinib has demonstrated efficacy in psoriatic arthritis in clinical trials, but its real-world performance in difficult-to-treat PsA remains underexplored. This observational, multicenter, open-label study evaluated the efficacy and safety of upadacitinib in 134 patients with psoriatic arthritis (97 women, mean age 51.8 ± 11.2 years, mean disease duration 9.94 ± 7.72 years) who showed inadequate response to advanced therapies. Most patients (74.6%) had received at least two biological/targeted synthetic disease-modifying antirheumatic drugs with different mechanisms of action. Upadacitinib was initiated at 15 mg daily, and within one month, significant improvements were observed: DAS28-ESR decreased from 4.7 to 3.77 (p < 0.001), DAPSA from 25 to 17 (p < 0.001), and CRP from 2.90 to 1.50 mg/L (p = 0.001). These reductions persisted throughout the study. Prednisone dosage decreased significantly (p = 0.049). Adverse events led to upadacitinib discontinuation in 8.2% of patients, but no serious adverse events were reported. Compared to the SELECT-PsA 2 trial, our cohort had a higher proportion of females and greater prior exposure to biologic agents but showed comparable efficacy and safety outcomes. These findings suggest that upadacitinib is a rapid, effective, and relatively safe therapeutic option for difficult-to-treat psoriatic arthritis under real-world conditions, supporting its use despite differing patient characteristics from clinical trial populations.

Authors

Institutions

Publication Details

Journal
Sci
Published
2025-05-14
DOI
https://doi.org/10.3390/sci7020067
Primary Topic
Spondyloarthritis Studies and Treatments
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Treatment with Upadacitinib in Difficult-to-Treat (D2T) Psoriatic Arthritis (PsA): A National Multicenter Study of the First 134 Patients in Clinical Practice

Mireia Moreno, Ana Urruticoechea‐Arana, María Luz García-Vivar, Beatriz Joven et al.
Sci
Spondyloarthritis Studies and Treatments
article

Treatment with Upadacitinib in Difficult-to-Treat (D2T) Psoriatic Arthritis (PsA): A National Multicenter Study of the First 134 Patients in Clinical Practice

Mireia Moreno, Ana Urruticoechea‐Arana, María Luz García-Vivar, Beatriz Joven, Luis Álvarez, E. Galíndez-Agirregoikoa, Cristina Clara Macía Villa, I. Urionaguena-Onaindia, Vega Jovaní, M. Pavía Pascual, Iñigo Gorostiza, María Ángeles Puche-Larrubia, C Vergara-Dangond, À. Martínez-Ferrer, Raquel Almodóvar, Rosario García‐Vicuña, Ricardo Blanco, T.L González, Diana Prieto-Peña, Joaquín María Belzunegui Otaño, C. Ramos Giráldez
article en

Abstract

Upadacitinib has demonstrated efficacy in psoriatic arthritis in clinical trials, but its real-world performance in difficult-to-treat PsA remains underexplored. This observational, multicenter, open-label study evaluated the efficacy and safety of upadacitinib in 134 patients with psoriatic arthritis (97 women, mean age 51.8 ± 11.2 years, mean disease duration 9.94 ± 7.72 years) who showed inadequate response to advanced therapies. Most patients (74.6%) had received at least two biological/targeted synthetic disease-modifying antirheumatic drugs with different mechanisms of action. Upadacitinib was initiated at 15 mg daily, and within one month, significant improvements were observed: DAS28-ESR decreased from 4.7 to 3.77 (p < 0.001), DAPSA from 25 to 17 (p < 0.001), and CRP from 2.90 to 1.50 mg/L (p = 0.001). These reductions persisted throughout the study. Prednisone dosage decreased significantly (p = 0.049). Adverse events led to upadacitinib discontinuation in 8.2% of patients, but no serious adverse events were reported. Compared to the SELECT-PsA 2 trial, our cohort had a higher proportion of females and greater prior exposure to biologic agents but showed comparable efficacy and safety outcomes. These findings suggest that upadacitinib is a rapid, effective, and relatively safe therapeutic option for difficult-to-treat psoriatic arthritis under real-world conditions, supporting its use despite differing patient characteristics from clinical trial populations.

SciVol. 7(2)
Hospital General Universitario Gregorio Marañón (ES), Hospital de Basurto (ES), Biogipuzkoa Health Research Institute (ES), Hospital Universitario Fundación Alcorcón (ES), Hospital Universitario 12 De Octubre (ES), Instituto de Investigación Marqués de Valdecilla (ES), Corporació Sanitària Parc Taulí (ES), Hospital de Galdakao (ES), Hospital Universitario Reina Sofía (ES), Hospital Universitario Doctor Peset (ES), Hospital Universitario de La Princesa (ES), Hospital General Universitario de Alicante Doctor Balmis (ES), Hospital Universitario de Valme (ES), Hospital Universitario Son Espases (ES), Hospital Universitario Infanta Sofía (ES), Hospital Universitario Ramón y Cajal (ES)
Openalex Percentile: Top 84%
Spondyloarthritis Studies and Treatments
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.