Meta-Analysis Finds Robust Evidence Supporting Upadacitinib for axSpA

Robust evidence supports the use of upadacitinib for the treatment of patients with axial spondyloarthritis (axSpA), according to a meta-analysis published in the journal Clinical Rheumatology.

“Upadacitinib exhibited satisfactory efficacy in treating axial spondyloarthritis, reducing disease activity and significantly enhancing patients' physical function, emotional well-being, and social engagement,” reported a team of researchers from Shandong University of Traditional Chinese Medicine, Shandong, China.

The meta-analysis included 5 randomized controlled trials assessing upadacitinib in 1246 patients with axSpA.

Patients treated with upadacitinib had significantly higher rates of achieving numerous outcomes, including Assessment of Spondyloarthritis International Society (ASAS) 20, ASAS40, ASAS partial remission, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50, and Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity, inactive disease, clinically important improvement, and major improvement, according to the study. The sole exception, researchers wrote, was Work Productivity and Activity Impairment (WPAI) absenteeism.

Meanwhile, upadacitinib was associated with “obvious improvements” in ASDAS-CRP, BASDAI, Modified BASDAI, Bath Ankylosing Spondylitis Functional Index, Canadian Spondyloarthritis Research Consortium MRI spine and sacroiliac joint, Ankylosing Spondylitis Quality of Life, ASAS Health Index, Bath Ankylosing Spondylitis Metrology Index, Maastricht Ankylosing Spondylitis Enthesitis Score, total back pain, nocturnal back pain, and WPAI overall work impairment, presenteeism, and activity impairment, researchers reported.

Incidence rates of adverse events and serious adverse events did not differ significantly between upadacitinib and placebo.

“Subgroup analysis revealed that disease subtype and age did not significantly affect efficacy,” the authors wrote, “and upadacitinib demonstrated comparable efficacy to adalimumab for axial spondyloarthritis.”

Reference

Tang H, Liu X, Zhao J, Tang Z, Zheng Z, Bai W. Upadacitinib for axial spondyloarthritis: a meta-analysis of efficacy and safety. Clin Rheumatol. 2024;43(8):2391-2402. doi:10.1007/s10067-024-07027-x