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Long-term Comparative Adherence and Switch Rates in Patients Receiving Advanced Therapies for Rheumatoid Arthritis

Christina Charles-Schoeman1, Kurt Oelke2, Patrick M Zueger3

  • 1Division of Rheumatology, Department of Medicine, Harbor-University of California Los Angeles Medical Centre, Los Angeles, CA, USA. ccharles@mednet.ucla.edu.

Rheumatology and Therapy
|July 14, 2026
PubMed
Summary

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Real-World Upadacitinib Persistence and Clinical Outcomes Among Canadian Patients with Inflammatory Arthritis from a Patient Support Program: The UPRAISE Study.

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Health Disparities in Rheumatology in the United States.

Open access rheumatology : research and reviews·2025

Upadacitinib (UPA) showed superior long-term adherence and lower switching rates compared to other advanced therapies in rheumatoid arthritis (RA) patients after discontinuing first-line tumor necrosis factor inhibitors (TNFi). This suggests UPA may offer better sustained treatment outcomes for RA management.

Area of Science:

  • Rheumatology
  • Pharmacology
  • Health Economics

Background:

  • Rheumatoid arthritis (RA) patients often fail first-line treatments, necessitating second-line options.
  • Limited data exist on long-term adherence and switching patterns for second-line therapies post-first-line tumor necrosis factor inhibitor (TNFi) discontinuation.

Purpose of the Study:

  • To compare long-term treatment adherence and switching rates among patients with RA initiating second-line upadacitinib (UPA) versus other advanced therapies after TNFi failure.

Main Methods:

  • Retrospective analysis of claims data (August 2018-October 2024) from patients aged ≥18 years with RA.
  • Included patients initiated UPA, tofacitinib (TOF), adalimumab (ADA), etanercept (ETA), abatacept (ABA), or tocilizumab (TOC) after discontinuing a first-line TNFi.
  • Adherence (≥80%) and switching outcomes were assessed at 1- and 3-year follow-ups.
Keywords:
AdherenceJAK inhibitorPersistenceReal-world evidenceRheumatoid arthritisTNF inhibitorTreatment sequencingUpadacitinib

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Main Results:

  • Upadacitinib (UPA) demonstrated the highest adherence rates at both 1-year (49.5%) and 3-year (35.7%) follow-ups.
  • Switching rates were lowest with UPA (28.6% at 1 year, 47.6% at 3 years) compared to other treatments, which approached ~60% by 3 years.
  • Patients on UPA were significantly less likely to switch treatment over 3 years compared to those on TOF, ADA, ETA, ABA, or TOC.

Conclusions:

  • Second-line upadacitinib (UPA) is associated with significantly greater long-term adherence and lower switching rates in RA patients who discontinued a first-line TNFi.
  • These findings suggest UPA may provide more sustained treatment effectiveness and potentially better patient outcomes in this population.