Impact of Upadacitinib on Laboratory Parameters and Related Adverse Events in Patients with RA: Integrated Data Up to 6.5 Years

Christina Charles-Schoeman; Jon T Giles; Nancy E Lane; Ernest Choy; Daniel E Furst; Jiří Vencovský; Anthony G Wilson; Gerd R Burmester; Derek Coombs; Sara K Penn; Nasser Khan; Jillian B Yee; Kassim Rahawi; Iain B McInnes

doi:10.1007/s40744-023-00624-3

Impact of Upadacitinib on Laboratory Parameters and Related Adverse Events in Patients with RA: Integrated Data Up to 6.5 Years

Rheumatol Ther. 2024 Feb;11(1):157-175. doi: 10.1007/s40744-023-00624-3. Epub 2024 Jan 5.

Authors

Christina Charles-Schoeman¹, Jon T Giles², Nancy E Lane³, Ernest Choy⁴, Daniel E Furst⁵, Jiří Vencovský^{6

7}, Anthony G Wilson⁸, Gerd R Burmester⁹, Derek Coombs¹⁰, Sara K Penn¹⁰, Nasser Khan¹⁰, Jillian B Yee¹⁰, Kassim Rahawi¹⁰, Iain B McInnes¹¹

Affiliations

¹ University of California, 1000 Veteran Avenue, Rm 32-59, Los Angeles, CA, 90095, USA. ccharles@mednet.ucla.edu.
² Columbia University, New York, NY, USA.
³ University of California Davis, Sacramento, CA, USA.
⁴ CREATE Centre, Cardiff University, Cardiff, UK.
⁵ Division of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
⁶ Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
⁷ Institute of Rheumatology, Na Slupi 4, 12850, Prague, Czech Republic.
⁸ Center for Arthritis Research, Conway Institute, University College Dublin, Dublin, Ireland.
⁹ Charité-Universitätsmedizin Berlin, Berlin, Germany.
¹⁰ AbbVie Inc., North Chicago, IL, USA.
¹¹ College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK.

Abstract

Introduction: Upadacitinib (UPA) is a Janus kinase inhibitor that has demonstrated efficacy in moderate-to-severe rheumatoid arthritis (RA) with an acceptable safety profile. We investigated laboratory parameter changes in UPA RA clinical trials.

Methods: Pooled data from six randomized trials in the SELECT phase 3 program were included. Key laboratory parameters and safety data were measured for UPA 15 and 30 mg once daily (QD), adalimumab (ADA) 40 mg every other week + methotrexate (MTX), and MTX monotherapy. Exposure-adjusted event rates (EAERs) of adverse events were calculated.

Results: A total of 3209 patients receiving UPA 15 mg QD (10 782.7 patient-years [PY]), 1204 patients receiving UPA 30 mg QD (3162.5 PY), 579 patients receiving ADA + MTX (1573.2 PY), and 314 patients receiving MTX monotherapy (865.1 PY) were included, representing up to 6.5 years of total exposure. Decreases in mean levels of hemoglobin, neutrophils, and lymphocytes, and increases in mean levels of liver enzymes and creatinine phosphokinase were observed with UPA, with grade 3 or 4 changes observed in some patients. Mean low- and high-density lipoprotein cholesterol ratios remained stable for patients receiving UPA 15 mg QD. EAERs of anemia and neutropenia occurred at generally consistent rates between UPA and active comparators (3.1-4.3 and 1.7-5.0 events [E]/100 PY across treatment groups, respectively). Rates of hepatic disorder were higher with MTX monotherapy, UPA 15 mg and UPA 30 mg (10.8, 9.7, and 11.0 E/100 PY, respectively) versus ADA + MTX (6.4 E/100 PY). Rates of lymphopenia were highest with MTX monotherapy (3.2 E/100 PY). Treatment discontinuations due to laboratory-related events were rare, occurring in 1.1% and 2.2% of patients treated with UPA 15 and 30 mg QD, respectively.

Conclusions: The results of this integrated long-term analysis of laboratory parameters continue to support an acceptable safety profile of UPA 15 mg QD for moderate-to-severe RA.

Keywords: JAK inhibitor; Laboratory parameters; Rheumatoid arthritis; Upadacitinib.