2026 article

Comparative treatment persistence of upadacitinib vs. tofacitinib in psoriatic arthritis: a multicenter observational study from the BIRRA cohort

Alessandro Conforti, Martina Gentile, Valerio Cipolloni, Laura Lucchetti, Marta Priora, Andrea Becciolini, Eleonora Celletti, Miriam Di Penta, Alberto Lo Gullo, Marino Paroli, Elena Bravi, Romina Andracco, Valeria Nucera, Francesca Ometto, Federica Lumetti, Antonella Farina, Matteo Colina, Viviana Ravagnani, Palma Scolieri, Maddalena Larosa, Elisa Visalli, Olga Addimanda, Rosetta Vitetta, Alessandro Volpe, Alessandra Bezzi, Francesco Girelli, Aldo Biagio Molica Colella, Rosalba Caccavale, Eleonora Di Donato, Giuditta Adorni, Daniele Santilli, Gianluca Lucchini, Eugenio Arrigoni, Emanuela Sabatini, Ilaria Platè, Natalia Mansueto, Aurora Ianniello, Enrico Fusaro, Maria Chiara Ditto, Vincenzo Bruzzese, Dario Camellino, Gerolamo Bianchi, Francesca Serale, Rosario Foti, Giorgio AMATO, Francesco De Lucia, Ylenia Dal Bosco, Roberta Foti, Massimo Reta, Alessia Fiorenza, Guido Rovera, Antonio Marchetta, Maria Cristina Focherini, Fabio Mascella, Simone Bernardi, Gilda Sandri, Dilia Giuggioli, Carlo Salvarani, Veronica Franchina, Francesco Molica Colella, Giulio Ferrero, Mirco Magnani, M. Maset, Camilla Mazzanti, Gianluca Santoboni, Claudio Angrisani, Massimiliano De Simone, Bernd Raffeiner, Simone Parisi, Alarico Ariani

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Background: Real-world comparative data on treatment persistence of upadacitinib and tofacitinib in psoriatic arthritis remain limited. Because persistence reflects treatment durability, tolerability, and perceived benefit in routine practice, it may serve as a pragmatic measure of real-world effectiveness. Objective: This study aimed to compare real-world treatment persistence between upadacitinib and tofacitinib in patients with psoriatic arthritis and to identify predictors of treatment discontinuation using data from the Italian multicenter BIRRA cohort. Methods: In this retrospective, multicenter, observational study, PsA patients treated with UPA and/or TOFA were enrolled from 34 rheumatology centers. Baseline demographics, treatment details, and disease activity (DAPSA) were collected. Treatment persistence was evaluated using Kaplan-Meier survival analysis. Cox proportional hazards models identified predictors of discontinuation, including sex, age, treatment line, prescription year, concomitant csDMARDs/steroids, PsA subtype (peripheral, axial, or mixed), and prior or current JAK inhibitor (JAKi) use. Results: Among 181 enrolled patients (UPA n = 124; TOFA n = 57), retention rates at 6, 12, and 18 months were 86%, 68%, and 54% for UPA and 78%, 60%, and 60% for TOFA (p = 0.7). Concomitant csDMARD therapy (HR: 1.92; 95% CI: 1.04– 3.54; p = 0.037) and later-line treatment (HR: 1.17; 95% CI: 1.01–1.35; p = 0.034) were independently associated with higher discontinuation risk. No statistically significant differences were observed between the two JAK inhibitors. Conclusion: UPA demonstrated a slightly longer persistence than TOFA, though the difference was not statistically significant after adjustment. Concomitant csDMARDs and later treatment lines significantly reduced persistence. These results suggest that PsA treatment retention may be influenced more by patient- and treatment-related factors than by the specific JAK inhibitor prescribed.

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Les sujets associés

Spondyloarthritis Studies and TreatmentsRheumatoid Arthritis Research and TherapiesPsoriasis: Treatment and Pathogenesis

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