Evaluating upadacitinib for the treatment of psoriatic arthritis

Expert Opin Pharmacother. 2022 Feb;23(2):169-173. doi: 10.1080/14656566.2021.2006183. Epub 2022 Jan 11.

Abstract

Introduction: Psoriatic arthritis is an extra-cutaneous manifestation affecting up to 40% of psoriasis patients with multiple therapies recommended by international guidelines including conventional and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs) as well as biologics. Janus kinase inhibitors (JAKis) have emerged as a unique therapeutic target with tofacitinib the first to gain FDA approval in 2017. The non-selectivity of older JAKis increases the risk of off-target effects such as suppression of hemopoiesis hence the rationale for more selective alternatives.

Areas covered: This paper explores the use of upadacitinib (a selective JAK1 inhibitor) for the treatment of psoriatic arthritis. It covers its chemical properties, pharmacokinetics, pharmacodynamics, efficacy, safety and regulation.

Expert opinion: In our opinion, upadacitinib is set to play an important role in the treatment of psoriatic arthritis as demonstrated by the SELECT-PsA trials especially in patients with poor or non-response to current first-line therapies. It's JAK1 receptor selectivity promises a lower side effect profile compared to the older nonselective JAKis but this will require confirmation with long-term clinical trial data.

Keywords: Janus kinase inhibitor; psoriatic arthritis; review; treatment; upadacitinib.

MeSH terms

  • Antirheumatic Agents* / adverse effects
  • Arthritis, Psoriatic* / drug therapy
  • Heterocyclic Compounds, 3-Ring / therapeutic use
  • Humans
  • Janus Kinase Inhibitors* / therapeutic use

Substances

  • Antirheumatic Agents
  • Heterocyclic Compounds, 3-Ring
  • Janus Kinase Inhibitors
  • upadacitinib