Fonseca Diogo, Nogueira Miguel, Torres Tiago
Department of Rheumatology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Drugs Context. 2023 Feb 28;12. doi: 10.7573/dic.2022-11-6. eCollection 2023.
Psoriatic arthritis is a chronic systemic inflammatory disease that presents with a variable clinical course and is typically associated with joint inflammation, together with cutaneous psoriasis. In recent decades, knowledge of the pathogenesis of psoriatic arthritis has advanced considerably and has allowed for development of new highly effective therapies, transforming the treatment landscape. Upadacitinib is a Janus kinase inhibitor (JAK) that is orally reversible with high selectivity for JAK1 and its signal transduction molecules. The results obtained in the phase III clinical trials (SELECT-PsA 1 and SELEC-PsA 2) demonstrated that upadacitinib was highly effective over placebo and non-inferior to adalimumab in several important domains of the disease. Improvements were observed in dactylitis, enthesitis and spondylitis as well as in physical function, pain, fatigue and overall quality of life. The safety profile of these results resembled that of adalimumab, apart from a slightly higher rate of herpes zoster infection, an increase of creatine kinase and an incidence of lymphopenia. However, none of these events was considered a serious adverse advent. Additionally, another analysis demonstrated that combining upadacitinib with methotrexate was associated with a similar efficacy to upadacitinib in monotherapy, both for patients that are naive to biologics treatment and for those previously treated with biologics. Therefore, upadacitinib is a new option for the treatment of psoriatic arthritis, presenting a series of beneficial characteristics. At this stage, it is important to collect long-term data to confirm the efficacy and safety profiles shown in clinical trials.
银屑病关节炎是一种慢性全身性炎症性疾病，临床病程多变，通常与关节炎症以及皮肤银屑病相关。近几十年来，银屑病关节炎的发病机制知识有了很大进展，使得新型高效疗法得以开发，改变了治疗格局。乌帕替尼是一种Janus激酶抑制剂（JAK），口服可逆，对JAK1及其信号转导分子具有高选择性。在III期临床试验（SELECT-PsA 1和SELECT-PsA 2）中获得的结果表明，在该疾病的几个重要领域，乌帕替尼比安慰剂高效，且不劣于阿达木单抗。在指（趾）炎、附着点炎和脊柱炎以及身体功能、疼痛、疲劳和总体生活质量方面均观察到改善。这些结果的安全性概况与阿达木单抗相似，只是带状疱疹感染率略高、肌酸激酶升高以及淋巴细胞减少的发生率有所增加。然而，这些事件均未被视为严重不良事件。此外，另一项分析表明，对于未接受过生物制剂治疗的患者以及先前接受过生物制剂治疗的患者，将乌帕替尼与甲氨蝶呤联合使用与乌帕替尼单药治疗的疗效相似。因此，乌帕替尼是治疗银屑病关节炎的一种新选择，具有一系列有益特性。在现阶段，收集长期数据以确认临床试验中显示的疗效和安全性概况非常重要。
