Comparative Effectiveness of Upadacitinib vs. Other JAK Inhibitors in Patients With Rheumatoid Arthritis in a Global Real-World Setting

INTRODUCTION: This study aimed to compare the real-world effectiveness of upadacitinib vs. other Janus kinase inhibitors (JAKis) in patients with rheumatoid arthritis (RA). METHODS: Data were extracted from the Adelphi RA Disease Specific Programme™ (DSP), a cross-sectional survey administered to rheumatologists and their patients in the EU, UK, Japan, Canada, and the US from July 2021 to February 2022. Patients receiving upadacitinib 15 mg or other JAKis, including tofacitinib, baricitinib, or peficitinib, for ≥ 6 months were included in the study. Data captured at treatment initiation and follow-up (≥ 6 months) included physician-evaluated pain rating and Disease Activity Score in 28 joints (DAS28). Fatigue and medication adherence were recorded at follow-up only. Inverse-probability-weighted regression adjustment was used to compare clinical outcomes at follow-up between patients treated with upadacitinib vs. other JAKis. RESULTS: Of 1440 total patients with RA, 1205 patients received upadacitinib and 235 received other JAKis. At study initiation, the majority of patients in both treatment groups had moderate/high disease activity (upadacitinib: 63.5%, other JAKis: 51.3%). At the most recent follow-up, after adjusting for differences in clinical characteristics between groups, patients treated with upadacitinib were significantly more likely to have attained physician-reported remission (54.3% vs. 44.1%, P = 0.030), have no pain (43.4% vs. 32.8%, P = 0.016), and have complete medication adherence (59.5% vs. 49.0%, P = 0.025) compared with patients treated with other JAKis. Of patients treated with upadacitinib, 42.5% were reported as having no fatigue compared with 36.1% of patients receiving other JAKis (P = 0.173). CONCLUSIONS: This real-world study of patients with RA showed that greater proportions of patients who received upadacitinib attained physician-reported DAS28 remission, absence of pain, and complete adherence to medication compared with patients receiving other JAKis.