Upadacitinib in psoriatic arthritis with prior TNF-inhibitor failure: a 56-week real-world study

Clin Exp Rheumatol. 2025; Advance online publication Epub ahead of print Doi: 10.55563/clinexprheumatol/gniy9i

Bakay et al. report  that upadacitinib (UPA) demonstrated sustained efficacy across musculoskeletal and skin domains in PsA patients with prior inadequate response to TNF inhibitors, with a safety profile consistent with previous reports.  Authors conducted a retrospective, single-centre observational study evaluating musculoskeletal disease activity, psoriasis, and patient-reported outcomes following initiation of UPA.

Salvato et al. showed that the combination of GC and b/tsDMARDs did not provide additional clinical benefits after 12 months, suggesting that chronic GC use alongside advanced therapies should be avoided. Authors assessed the impact of chronic oral low-dose GCs on the efficacy and retention rates of JAKi compared to other mechanisms of action (OMA) therapies in a cohort of RA patients with inadequate response to TNFi.

November 2025

Bai et al. reported that JAKi therapy was associated with a reduced risk of incident uveitis compared with TNF inhibitors among patients with AS, PsO, or PsA. Authors conducted a large-scale, real world comparative study which evaluated the risk of incident uveitis among patients with psoriatic disease and AS treated with either TNFi or JAKi.

Bennett et al, showed that tofacitinib treatment in adults with rheumatoid arthritis led to a significant increase in lower limb and thigh muscle volume, accompanied by rises in serum creatinine without evidence of renal impairment.

Nozaki et al. showed that JAK inhibitor treatment provided sustained disease control (especially in high-risk RA patients) and promoted GC reduction, although TNF inhibitors remain a standard option. Nozaki et al. evaluated the clinical efficacy and continuation rates of JAK inhibitors and TNF inhibitors in RA patients with poor-prognosis factors (PPFs).

Hernández-Hernández et al. showed that in a real-world clinical settings, UPA persistence is lower among RA patients who have received prior IL-6i treatment; and that treatment strategies to avoid UPA in patients with cardiovascular risk (CVR) appear to be primarily driven by pivotal safety studies rather than regulatory guidance.

September 2025

Most patients vaccinated with RZV while using UPA 15mg QD and background MTX achieved satisfactory humoral and cell-mediated immune responses to recombinant zoster vaccine (RZV) at Weeks 4, 16 and 60. Winthrop et al. evaluated the immunogenicity of RZV through Week 60 in patients with RA who were receiving UPA 15mg QD and background MTX.

August 2025

Baraliakos et al. compared real-world effectiveness of upadacitinib, TNF inhibitors, or IL-17 inhibitors following inadequate response to an initial TNF inhibitor in patients with axSpA. Upadacitinib was associated with greater reductions in pain and fewer affected joints compared with switching to a second TNF inhibitor or IL-17 inhibitor.

UPA has shown effectiveness in treating IMIDs like RA, axSpA, PsA, CD, and UC. Chai et al. evaluated evidence from a synthesis of RCTs and provided insights that may guide clinical decision-making and improve treatment outcomes for IMIDs. UPA effectively alleviated symptoms, reduced disease activity, and showed notable benefits in improving quality of life.

July 2025

Wieczorek et al. present the first evidence supporting the use of a dual JAK and ROCK inhibitor as a potential treatment option for patients with RA who have inadequate response to MTX. Wieczorek et al. conducted a randomised, Phase 2 study of CPL’116 in patients with RA with inadequate response to MTX, to evaluate dose-dependent effects on disease control and pharmacokinetics, and its effect on laboratory abnormalities among other safety assessments.