Persistence and effectiveness of upadacitinib and TNFi for rheumatoid arthritis using pooled data from Canadian and...

The ROSA study evaluated real-world persistence and effectiveness of upadacitinib and tumour necrosis factor inhibitors (TNFi) in patients with rheumatoid arthritis (RA), using data from two Canadian registries, RHUMADATA and Ontario Best Practices Research Initiative (OBRI), and the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry.

This observational study analysed data from 990 patients with RA who initiated upadacitinib or TNFi between 1 January 2020 and 30 June 2023. Multiple imputation was used for baseline covariates with missing data and results were adjusted for propensity scores derived from pre-specified variables (age, disease duration, prior treatments, comorbidities, etc.). Persistence was assessed using Kaplan-Meier and Cox proportional hazard regression models. Effectiveness was evaluated using observed (non-imputed) disease activity indices over 6 and 12 months.

Overall, 174, 216 and 600 patients were included from the RHUMADATA, OBRI, SCQM registries, respectively. Patients using upadacitinib had a lower risk of discontinuing treatment than patients using TNFi [hazard-ratio (HR) (95% CI): 0.602 (0.469, 0.773)] and this was unaffected by previous exposure to advanced treatment. Concomitant use of any csDMARD HR (95% CI); [upadacitinib: 0.225 (0.107, 0.471); TNFi: 0.516 (0.303, 0.881)], and methotrexate [upadacitinib: 0.604 (0.390, 0.934); TNFi: 0.694 (0.522, 0.925)] were associated with improved persistence for both groups. A similar proportion of patients receiving upadacitinib or TNFi achieved Clinical Disease Activity Index low disease activity or remission at 6 months (70.8% vs 61.0%; P = 0.1541) and 12 months (70.5% vs 75.2%; P = 0.4494).

Canadian and Swiss patients with RA had longer persistence with upadacitinib than TNFi, independent of previous advanced treatments.