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.

November 2025

Data by Flouri et al. support greater drug persistence with secukinumab than with TNF inhibitors in patients with axSpA and peripheral spondyloarthritis, both with respect to efficacy- and safety-related discontinuations, while the achievement of 6-month treatment targets was comparable. Flouri et al. compared long term treatment persistence, efficacy and safety between secukinumab and TNF inhibitors in a cohort of patients with SpA treated in real life.

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.

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).

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.

June 2025

Silvagni et al. aimed to comparatively assess the risk of cardiovascular events (CVE) in RA patients treated with JAKis or TNFis and to explore the interactions with patient profiles [including age, baseline cardio-cerebrovascular (CV) risk, and frailty, which is a state of decreased physiological reserve, assessed using a validated frailty index for Administrative Heathcare Databases (AHD)]. This AHD-based study highlighted no significantly increased risk of CVEs or MACEs for JAKis with respect to TNFis. The CV risk remains mainly driven by the patient profiles. The frailty, in parallel with baseline CV risk, emerged as an important determinant of CVEs, MACEs, and thromboembolic events (TEs). Frailty and baseline CV risk are key predictors of CVEs, MACEs, and TEs, and should be considered in both clinical assessment and trial design for RA patients on ts/b-DMARDs.