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

• DOI: 10.3390/sci7020067
• Publication Date: 2025-05-14T16:22:17Z
• Authors: Eva Galíndez-Agir...; Diana Prieto-Peña; Maria Luz García-...; Joaquin Maria Bel...; Beatriz Joven-Ibáñez; Cristina Vergara-...; Marina Pavía-Pascual; Irati Urionaguena...; Lucia Vega Alvarez; M. Ángeles Puche ...; Consuelo Ramos Gi...; Rosario Garcia-Vi...; Vega Jovani; Angels Martínez-F...; Mireia Moreno Mar...; Teresa González H...; Raquel Almodóvar ...; Ana Urruticoechea...; Cristina Macía-Villa; Inigo Gorostiza; Ricardo Blanco Al...

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.