Going Forward
Longer and larger trials are needed to further analyze the effects and risks of upadacitinib and its effects compared with other drugs for PsA, McInnes et al. conclude.
The availability of more treatments for PsA is welcome considering that few new modalities existed until recently, says study author Iain B. McInnes, FRCP, PhD, professor of rheumatology and director of the Institute of Infection, Immunity and Inflammation at the University of Glasgow, Scotland, U.K. He points to several new pathways for PsA treatment, including JAKs, interleukin (IL) 17A, IL-12/23p40, IL-23p19, and phosphodiesterase 4, as well as TNF inhibitors.
“More [treatments] are on the way, which is very exciting,” Dr. McInnes says.
Vivian P. Bykerk, MD, FRCPC, professor of medicine and director of the Inflammatory Arthritis Center at the Hospital for Special Surgery, New York, sees the results as encouraging but also notes the 30 mg dose of upadacitinib was associated with more safety concerns and severe adverse advents. If this dose is approved for use in patients with PsA, providers will need to use its with caution, she notes, adding that upadacitinib 15 mg daily is a very good option for treatment of PsA, with a safety profile consistent with JAK inhibitors in other trials. If physicians choose JAKs for PsA, they should continue to monitor lab results for changes, Dr. Bykerk adds.
“The next steps require that we understand the best order of therapeutic intervention and which patient groups will benefit from the variety of modes of action now available to us,” Dr. McInnes says.
Vanessa Caceres is a medical writer in Bradenton, Fla.
References
- McInnes IB, Anderson JK, Magrey M, et al. Trial of upadacitinib and adalimumab for psoriatic arthritis. N Engl J Med. 2021 Apr 1;384(13):1227–1239.
- Losavio K. FDA Requires new Boxed Warnings on JAK inhibitors, places restrictions on use. 2021 Sep 1. The-Rheumatologist.org.