Psoriatic Arthritis
Conditions
Keywords
Arthritis, Psoriasis, Anti-Rheumatic, Anti-inflammatory, Joint disease, Musculoskeletal disease
Brief summary
This is a Phase 3 multicenter study that included two periods. Period 1 was designed to compare the safety, tolerability, and efficacy of upadacitinib 15 mg once daily (QD) and 30 mg QD versus placebo in participants with moderately to severely active Psoriatic Arthritis (PsA) who had an inadequate response to Biological Disease Modifying Anti-Rheumatic Drug (bDMARDs). Period 2 evaluated the safety, tolerability and efficacy of upadacitinib 15 mg QD and 30 mg QD in subjects with PsA who completed Period 1.
Detailed description
The study included a 35-day screening period; a 56-week blinded period which included 24 weeks of randomized, double-blind, parallel-group, placebo-controlled treatment followed by an additional 32 weeks of treatment blinded to the dose of upadacitinib (Period 1); a long-term extension period of up to a total treatment duration of up to approximately 3 years (Period 2); and a 30-day follow-up call or visit. All participants in Period 1 who were randomized to receive Placebo up to 24 weeks were pooled for the assessment of all outcome measures. All participants receiving upadacitinib 30 mg QD during Period 2 were switched to upadacitinib 15 mg QD following a protocol amendment and were pooled for AE reporting.
Interventions
Oral tablet
Oral tablet
Sponsors
Study design
Eligibility
Inclusion criteria
* Clinical diagnosis of PsA with symptom onset at least 6 months prior to the Screening Visit and fulfillment of the Classification Criteria for PsA (CASPAR) criteria * Participant has active disease at Baseline defined as \>= 3 tender joints (based on 68 joint counts) and \>= 3 swollen joints (based on 66 joint counts) at Screening and Baseline Visits * Diagnosis of active plaque psoriasis or documented history of plaque psoriasis * Participant has had an inadequate response (lack of efficacy after a minimum 12 week duration of therapy) or intolerance to treatment with at least 1 bDMARD.
Exclusion criteria
* Prior exposure to any Janus Kinase (JAK) inhibitor (including but not limited to ruxolitinib, tofacitinib, baricitinib, and filgotinib) * Current treatment with \> 2 non-biologic DMARDs or use of DMARDs other than Methotrexate (MTX), Sulfasalazine (SSZ), Leflunomide (LEF), apremilast, Hydroxychloroquine (HCQ), bucillamine or iguratimod or use of MTX in combination with LEF at Baseline. * History of fibromyalgia, any arthritis with onset prior to age 17 years, or current diagnosis of inflammatory joint disease other than PsA (including, but not limited to rheumatoid arthritis, gout, overlap connective tissue diseases, scleroderma, polymyositis, dermatomyositis, systemic lupus erythematosus). Prior history of reactive arthritis or axial spondyloarthritis including ankylosing spondylitis and non-radiographic axial spondyloarthritis is permitted if documentation of change in diagnosis to PsA or additional diagnosis of PsA is made. Prior history of fibromyalgia is permitted if documentation of change in diagnosis to PsA or documentation that the diagnosis of fibromyalgia was made incorrectly.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 12 | Baseline and Week 12 | Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR20 response criteria: 1. ≥ 20% improvement in 68-tender joint count; 2. ≥ 20% improvement in 66-swollen joint count; and 3. ≥ 20% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Achieving a Static Investigator Global Assessment (sIGA) of Psoriasis of 0 or 1 and at Least a 2-point Improvement From Baseline (sIGA 0/1) at Week 16 | Baseline and Week 16 | The sIGA is a 5 point scale ranging from 0 to 4, based on the investigator's assessment of the average elevation, erythema, and scaling of all psoriatic lesions at the current visit. A lower score indicates less severe psoriasis (0 = clear, 1 = almost clear, 2 = mild, 3 = moderate and 4 = severe). |
| Percentage of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response at Week 16 | Baseline and Week 16 | PASI is a composite score based on the percentage of the body surface area (BSA) affected by psoriasis and the intensity of erythema (reddening), induration (thickening or hardening of the skin), and desquamation (peeling of the skin) of lesions assessed at 4 anatomic sites (head, upper extremities, trunk, and lower extremities). At each location, the percentage of BSA involvement is assigned a score from 0 (no involvement) to 6 (90% to 100% involvement), and erythema, induration, and desquamation are scored on a scale from 0 (no symptoms) to 4 (very marked). The PASI score ranges from 0 (no psoriasis) to 72 (very severe psoriasis). A PASI-75 response is the percentage of participants who achieved at least a 75% reduction (improvement) from Baseline in PASI score. |
| Change From Baseline in Short-Form 36 (SF-36) Physical Component Score (PCS) at Week 12 | Baseline and Week 12 | The Short Form 36-Item Health Survey (SF-36) Version 2 is a self-administered questionnaire that measures the impact of disease on overall quality of life during the past 4 weeks. The SF-36 consists of 36 questions in eight domains (physical function, pain, general and mental health, vitality, social function, physical and emotional health). The physical component score is a weighted combination of the 8 subscales with positive weighting for physical functioning, role-physical, bodily pain, and general health. The PCS was calculated using norm-based scoring so that 50 is the average score and the standard deviation equals 10. Higher scores are associated with better functioning/quality of life; a positive change from Baseline score indicates an improvement. |
| Change From Baseline in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Score at Week 12 | Baseline and Week 12 | The FACIT-Fatigue questionnaire is a self-administered patient questionnaire that consists of 13 questions designed to measure the degree of fatigue experienced by participants in the previous 7 days, including physical fatigue (e.g., I feel tired), functional fatigue (e.g., trouble finishing things), emotional fatigue (e.g., frustration), and social consequences of fatigue (e.g., limits social activity). Participants respond to the questions on a scale from 0 'not at all' to 4 'very much'. The FACIT Fatigue score is computed by summing the item scores, after reversing those items that are worded in the negative direction. The FACIT-Fatigue subscale score ranges from 0 to 52, where higher scores represent less fatigue. A positive change from Baseline indicates improvement. |
| Change From Baseline in Health Assessment Questionnaire Disability Index (HAQ-DI) at Week 12 | Baseline and Week 12 | The Health Assessment Questionnaire - Disability Index is a patient-reported questionnaire that measures the degree of difficulty a person has in accomplishing tasks in 8 functional areas (dressing, arising, eating, walking, hygiene, reaching, gripping, and errands and chores) over the past week. Participants assessed their ability to do each task on a scale from 0 (without any difficulty) to 3 (unable to do). Scores were averaged to provide an overall score ranging from 0 to 3, where 0 represents no disability and 3 represents very severe, high-dependency disability. A negative change from Baseline in the overall score indicates improvement. |
| Change From Baseline in Self-Assessment of Psoriasis Symptoms (SAPS) Score at Week 16 | Baseline and Week 16 | The SAPS is an 11-item self-assessment of psoriasis symptoms that includes questions on: pain, itching, redness, scaling, flaking, bleeding, burning, stinging, tenderness, pain due to skin cracking, and joint pain. Each item is scored from 0 to 10, with 0 being least severe and 10 being most severe. The total score is generated by summing the 11 items and ranges from 0 to 110 (worst). A negative change from Baseline in the total score indicates improvement. |
| Percentage of Participants With an American College of Rheumatology 50% (ACR50) Response at Week 12 | Baseline and Week 12 | Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR50 response criteria: 1. ≥ 50% improvement in 68-tender joint count; 2. ≥ 50% improvement in 66-swollen joint count; and 3. ≥ 50% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP). |
| Percentage of Participants With an American College of Rheumatology 70% (ACR70) Response at Week 12 | Baseline and Week 12 | Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR70 response criteria: 1. ≥ 70% improvement in 68-tender joint count; 2. ≥ 70% improvement in 66-swollen joint count; and 3. ≥ 70% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP). |
| Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 2 | Baseline and Week 2 | Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR20 response criteria: 1. ≥ 20% improvement in 68-tender joint count; 2. ≥ 20% improvement in 66-swollen joint count; and 3. ≥ 20% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP). |
| Percentage of Participants Achieving Minimal Disease Activity (MDA) at Week 24 | Week 24 | A participant was classified as achieving MDA if 5 of the following 7 criteria were met: * Tender joint count (out of 68 joints) ≤ 1 * Swollen joint count (out of 66 joints) ≤ 1 * PASI score ≤ 1 (score ranges from 0 - 72) or percent BSA involved with psoriasis ≤ 3% * Patient's assessment of pain ≤ 1.5 (NRS from 0 to 10) * Patient's Global Assessment of disease activity ≤ 2 (NRS from 0 to 10) * HAQ-DI score ≤ 0.5 (index score ranges from 0 to 3) * Leeds Enthesitis Index ≤ 1 (assesses the presence or absence of enthesitis at 3 bilateral sites, with an overall score range from 0 to 6) |
Countries
Australia, Belgium, Brazil, Canada, Chile, Czechia, France, Greece, Hungary, Italy, Japan, Netherlands, New Zealand, Portugal, Puerto Rico, South Korea, Spain, United Kingdom, United States
Participant flow
Recruitment details
This study was conducted at 123 sites in 16 countries (Belgium, Brazil, Canada, Chile, Czech Republic, France, Greece, Hungary, Italy, Japan, Netherlands, New Zealand, Portugal, Spain, United Kingdom, United States \[including Puerto Rico\]). Adults with active psoriatic arthritis (PsA) and a history of inadequate response or intolerance to at least one biologic disease modifying anti-rheumatic drug (bDMARD) were enrolled.
Pre-assignment details
Participants were randomly assigned at a 1:1:2:2 ratio to one of four treatment groups below. Randomization was stratified by extent of psoriasis (≥ 3% body surface area \[BSA\] or \< 3% BSA), current use of at least 1 DMARD, and number of prior failed biologic DMARDs (1 vs \> 1), except for participants from Japan, for whom randomization was stratified by extent of psoriasis (≥ 3% BSA or \< 3% BSA) only.
Participants by arm
| Arm | Count |
|---|---|
| Placebo Participants received placebo once daily for 24 weeks. This group includes all participants who went on to receive upadacitinib 15 mg or upadacitinib 30 mg after week 24. | 212 |
| Upadacitinib 15 mg Participants received upadacitinib 15 mg once daily for 24 weeks. | 211 |
| Upadacitinib 30 mg Participants received upadacitinib 30 mg once daily for 24 weeks. | 218 |
| Total | 641 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Period 1 | Adverse Event | 7 | 7 | 12 | 14 |
| Period 1 | Lack of Efficacy | 6 | 7 | 12 | 6 |
| Period 1 | Lost to Follow-up | 4 | 4 | 6 | 8 |
| Period 1 | One participant did not qualify per inclusion/exclusion criteria and discontinued prior to treatment | 0 | 0 | 0 | 1 |
| Period 1 | Other | 2 | 2 | 4 | 7 |
| Period 1 | Withdrawal by Subject | 18 | 9 | 10 | 17 |
| Period 2 | Adverse Event | 4 | 7 | 10 | 10 |
| Period 2 | COVID-19 Infection | 0 | 0 | 1 | 0 |
| Period 2 | Lack of Efficacy | 2 | 4 | 7 | 4 |
| Period 2 | Lost to Follow-up | 2 | 2 | 3 | 5 |
| Period 2 | Other | 3 | 2 | 2 | 4 |
| Period 2 | Withdrawal by Subject | 3 | 7 | 13 | 16 |
Baseline characteristics
| Characteristic | Placebo | Upadacitinib 15 mg | Upadacitinib 30 mg | Total |
|---|---|---|---|---|
| Age, Continuous | 54.1 years STANDARD_DEVIATION 11.53 | 53.0 years STANDARD_DEVIATION 12.02 | 53.0 years STANDARD_DEVIATION 11.94 | 53.4 years STANDARD_DEVIATION 11.83 |
| Duration of PsA Diagnosis | 11.0 years STANDARD_DEVIATION 10.33 | 9.6 years STANDARD_DEVIATION 8.36 | 9.7 years STANDARD_DEVIATION 8.71 | 10.1 years STANDARD_DEVIATION 9.18 |
| Duration of Psoriatic Arthritis Symptoms | 14.6 years STANDARD_DEVIATION 11.7 | 12.2 years STANDARD_DEVIATION 8.81 | 13.3 years STANDARD_DEVIATION 10.84 | 13.4 years STANDARD_DEVIATION 10.54 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 53 Participants | 36 Participants | 50 Participants | 139 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 159 Participants | 175 Participants | 168 Participants | 502 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Extent of Psoriasis < 3% BSA | 81 Participants | 81 Participants | 87 Participants | 249 Participants |
| Extent of Psoriasis ≥ 3% BSA | 131 Participants | 130 Participants | 131 Participants | 392 Participants |
| Health Assessment Questionnaire - Disability Index (HAQ-DI) | 1.23 units on a scale STANDARD_DEVIATION 0.69 | 1.10 units on a scale STANDARD_DEVIATION 0.61 | 1.19 units on a scale STANDARD_DEVIATION 0.66 | 1.17 units on a scale STANDARD_DEVIATION 0.66 |
| High-sensitivity C-reactive Protein (hsCRP) | 10.40 mg/L STANDARD_DEVIATION 18.46 | 11.16 mg/L STANDARD_DEVIATION 18.55 | 10.53 mg/L STANDARD_DEVIATION 17.21 | 10.69 mg/L STANDARD_DEVIATION 18.05 |
| Number of Prior Failed Biologic DMARDs 0 bDMARDS | 18 Participants | 16 Participants | 17 Participants | 51 Participants |
| Number of Prior Failed Biologic DMARDs 1 bDMARD | 135 Participants | 126 Participants | 130 Participants | 391 Participants |
| Number of Prior Failed Biologic DMARDs 2 bDMARDS | 35 Participants | 35 Participants | 46 Participants | 116 Participants |
| Number of Prior Failed Biologic DMARDs ≥ 3 bDMARDS | 24 Participants | 34 Participants | 25 Participants | 83 Participants |
| Patient's Assessment of Pain | 6.6 units on a scale STANDARD_DEVIATION 2.12 | 6.4 units on a scale STANDARD_DEVIATION 2.13 | 6.2 units on a scale STANDARD_DEVIATION 2.21 | 6.4 units on a scale STANDARD_DEVIATION 2.16 |
| Patient's Global Assessment of Disease Activity | 6.8 units on a scale STANDARD_DEVIATION 2.04 | 6.8 units on a scale STANDARD_DEVIATION 1.91 | 6.7 units on a scale STANDARD_DEVIATION 2.15 | 6.8 units on a scale STANDARD_DEVIATION 2.04 |
| Physician's Global Assessment of Disease Activity | 6.5 units on a scale STANDARD_DEVIATION 1.76 | 6.5 units on a scale STANDARD_DEVIATION 1.8 | 6.6 units on a scale STANDARD_DEVIATION 1.73 | 6.5 units on a scale STANDARD_DEVIATION 1.76 |
| Race/Ethnicity, Customized American Indian/Alaska Native | 0 Participants | 3 Participants | 0 Participants | 3 Participants |
| Race/Ethnicity, Customized Asian | 17 Participants | 19 Participants | 16 Participants | 52 Participants |
| Race/Ethnicity, Customized Black or African American | 7 Participants | 5 Participants | 5 Participants | 17 Participants |
| Race/Ethnicity, Customized Multiple | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race/Ethnicity, Customized Native Hawaiian or other Pacific Islander | 1 Participants | 1 Participants | 1 Participants | 3 Participants |
| Race/Ethnicity, Customized White | 186 Participants | 183 Participants | 196 Participants | 565 Participants |
| Sex: Female, Male Female | 120 Participants | 113 Participants | 115 Participants | 348 Participants |
| Sex: Female, Male Male | 92 Participants | 98 Participants | 103 Participants | 293 Participants |
| Swollen Joint Count | 12.0 joints STANDARD_DEVIATION 8.85 | 11.3 joints STANDARD_DEVIATION 8.19 | 12.9 joints STANDARD_DEVIATION 9.41 | 12.1 joints STANDARD_DEVIATION 8.85 |
| Tender Joint Count | 25.3 joints STANDARD_DEVIATION 17.62 | 24.9 joints STANDARD_DEVIATION 17.27 | 24.2 joints STANDARD_DEVIATION 15.87 | 24.8 joints STANDARD_DEVIATION 16.91 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk | EG006 affected / at risk | EG007 affected / at risk | EG008 affected / at risk | EG009 affected / at risk |
|---|---|---|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 211 | 0 / 219 | 1 / 212 | 0 / 79 | 0 / 90 | 5 / 167 | 0 / 165 | 0 / 69 | 2 / 77 | 0 / 87 |
| other Total, other adverse events | 111 / 211 | 139 / 219 | 87 / 212 | 32 / 79 | 34 / 90 | 111 / 167 | 99 / 165 | 42 / 69 | 49 / 77 | 34 / 87 |
| serious Total, serious adverse events | 22 / 211 | 25 / 219 | 5 / 212 | 3 / 79 | 6 / 90 | 24 / 167 | 19 / 165 | 7 / 69 | 12 / 77 | 5 / 87 |
Outcome results
Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 12
Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR20 response criteria: 1. ≥ 20% improvement in 68-tender joint count; 2. ≥ 20% improvement in 66-swollen joint count; and 3. ≥ 20% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
Time frame: Baseline and Week 12
Population: Full analysis set; participants who prematurely discontinued from study drug prior to Week 12 or for whom ACR data were missing at Week 12 were considered non-responders.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 12 | 24.1 percentage of participants |
| Upadacitinib 15 mg | Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 12 | 56.9 percentage of participants |
| Upadacitinib 30 mg | Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 12 | 63.8 percentage of participants |
Change From Baseline in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Score at Week 12
The FACIT-Fatigue questionnaire is a self-administered patient questionnaire that consists of 13 questions designed to measure the degree of fatigue experienced by participants in the previous 7 days, including physical fatigue (e.g., I feel tired), functional fatigue (e.g., trouble finishing things), emotional fatigue (e.g., frustration), and social consequences of fatigue (e.g., limits social activity). Participants respond to the questions on a scale from 0 'not at all' to 4 'very much'. The FACIT Fatigue score is computed by summing the item scores, after reversing those items that are worded in the negative direction. The FACIT-Fatigue subscale score ranges from 0 to 52, where higher scores represent less fatigue. A positive change from Baseline indicates improvement.
Time frame: Baseline and Week 12
Population: Full analysis set participants with available data; a mixed effect model repeat measurement (MMRM) analysis with longitudinal data from observed cases up to Week 12 was used.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Placebo | Change From Baseline in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Score at Week 12 | 1.3 score on a scale |
| Upadacitinib 15 mg | Change From Baseline in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Score at Week 12 | 5.0 score on a scale |
| Upadacitinib 30 mg | Change From Baseline in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) Score at Week 12 | 6.1 score on a scale |
Change From Baseline in Health Assessment Questionnaire Disability Index (HAQ-DI) at Week 12
The Health Assessment Questionnaire - Disability Index is a patient-reported questionnaire that measures the degree of difficulty a person has in accomplishing tasks in 8 functional areas (dressing, arising, eating, walking, hygiene, reaching, gripping, and errands and chores) over the past week. Participants assessed their ability to do each task on a scale from 0 (without any difficulty) to 3 (unable to do). Scores were averaged to provide an overall score ranging from 0 to 3, where 0 represents no disability and 3 represents very severe, high-dependency disability. A negative change from Baseline in the overall score indicates improvement.
Time frame: Baseline and Week 12
Population: Full analysis set participants with available data; a mixed effect model repeat measurement (MMRM) analysis with longitudinal data from observed cases up to Week 12 was used.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Placebo | Change From Baseline in Health Assessment Questionnaire Disability Index (HAQ-DI) at Week 12 | -0.10 score on a scale |
| Upadacitinib 15 mg | Change From Baseline in Health Assessment Questionnaire Disability Index (HAQ-DI) at Week 12 | -0.30 score on a scale |
| Upadacitinib 30 mg | Change From Baseline in Health Assessment Questionnaire Disability Index (HAQ-DI) at Week 12 | -0.41 score on a scale |
Change From Baseline in Self-Assessment of Psoriasis Symptoms (SAPS) Score at Week 16
The SAPS is an 11-item self-assessment of psoriasis symptoms that includes questions on: pain, itching, redness, scaling, flaking, bleeding, burning, stinging, tenderness, pain due to skin cracking, and joint pain. Each item is scored from 0 to 10, with 0 being least severe and 10 being most severe. The total score is generated by summing the 11 items and ranges from 0 to 110 (worst). A negative change from Baseline in the total score indicates improvement.
Time frame: Baseline and Week 16
Population: Full analysis set participants with available data; a mixed effect model repeat measurement (MMRM) analysis with longitudinal data from observed cases up to Week 16 was used.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Placebo | Change From Baseline in Self-Assessment of Psoriasis Symptoms (SAPS) Score at Week 16 | -1.5 score on a scale |
| Upadacitinib 15 mg | Change From Baseline in Self-Assessment of Psoriasis Symptoms (SAPS) Score at Week 16 | -24.4 score on a scale |
| Upadacitinib 30 mg | Change From Baseline in Self-Assessment of Psoriasis Symptoms (SAPS) Score at Week 16 | -29.7 score on a scale |
Change From Baseline in Short-Form 36 (SF-36) Physical Component Score (PCS) at Week 12
The Short Form 36-Item Health Survey (SF-36) Version 2 is a self-administered questionnaire that measures the impact of disease on overall quality of life during the past 4 weeks. The SF-36 consists of 36 questions in eight domains (physical function, pain, general and mental health, vitality, social function, physical and emotional health). The physical component score is a weighted combination of the 8 subscales with positive weighting for physical functioning, role-physical, bodily pain, and general health. The PCS was calculated using norm-based scoring so that 50 is the average score and the standard deviation equals 10. Higher scores are associated with better functioning/quality of life; a positive change from Baseline score indicates an improvement.
Time frame: Baseline and Week 12
Population: Full analysis set participants with available data; a mixed effect model repeat measurement (MMRM) analysis with longitudinal data from observed cases up to Week 12 was used.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Placebo | Change From Baseline in Short-Form 36 (SF-36) Physical Component Score (PCS) at Week 12 | 1.62 score on a scale |
| Upadacitinib 15 mg | Change From Baseline in Short-Form 36 (SF-36) Physical Component Score (PCS) at Week 12 | 5.15 score on a scale |
| Upadacitinib 30 mg | Change From Baseline in Short-Form 36 (SF-36) Physical Component Score (PCS) at Week 12 | 7.06 score on a scale |
Percentage of Participants Achieving a Static Investigator Global Assessment (sIGA) of Psoriasis of 0 or 1 and at Least a 2-point Improvement From Baseline (sIGA 0/1) at Week 16
The sIGA is a 5 point scale ranging from 0 to 4, based on the investigator's assessment of the average elevation, erythema, and scaling of all psoriatic lesions at the current visit. A lower score indicates less severe psoriasis (0 = clear, 1 = almost clear, 2 = mild, 3 = moderate and 4 = severe).
Time frame: Baseline and Week 16
Population: Full analysis set participants with a Baseline sIGA score ≥ 2; participants who prematurely discontinued from study drug prior to Week 16 or for whom sIGA data were missing at Week 16 were considered non-responders.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants Achieving a Static Investigator Global Assessment (sIGA) of Psoriasis of 0 or 1 and at Least a 2-point Improvement From Baseline (sIGA 0/1) at Week 16 | 9.2 percentage of participants |
| Upadacitinib 15 mg | Percentage of Participants Achieving a Static Investigator Global Assessment (sIGA) of Psoriasis of 0 or 1 and at Least a 2-point Improvement From Baseline (sIGA 0/1) at Week 16 | 36.8 percentage of participants |
| Upadacitinib 30 mg | Percentage of Participants Achieving a Static Investigator Global Assessment (sIGA) of Psoriasis of 0 or 1 and at Least a 2-point Improvement From Baseline (sIGA 0/1) at Week 16 | 40.2 percentage of participants |
Percentage of Participants Achieving Minimal Disease Activity (MDA) at Week 24
A participant was classified as achieving MDA if 5 of the following 7 criteria were met: * Tender joint count (out of 68 joints) ≤ 1 * Swollen joint count (out of 66 joints) ≤ 1 * PASI score ≤ 1 (score ranges from 0 - 72) or percent BSA involved with psoriasis ≤ 3% * Patient's assessment of pain ≤ 1.5 (NRS from 0 to 10) * Patient's Global Assessment of disease activity ≤ 2 (NRS from 0 to 10) * HAQ-DI score ≤ 0.5 (index score ranges from 0 to 3) * Leeds Enthesitis Index ≤ 1 (assesses the presence or absence of enthesitis at 3 bilateral sites, with an overall score range from 0 to 6)
Time frame: Week 24
Population: Full analysis set; participants who prematurely discontinued from study drug prior to Week 24 or for whom data were missing at Week 24, or who met rescue criteria at Week 16 were considered non-responders.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants Achieving Minimal Disease Activity (MDA) at Week 24 | 2.8 percentage of participants |
| Upadacitinib 15 mg | Percentage of Participants Achieving Minimal Disease Activity (MDA) at Week 24 | 25.1 percentage of participants |
| Upadacitinib 30 mg | Percentage of Participants Achieving Minimal Disease Activity (MDA) at Week 24 | 28.9 percentage of participants |
Percentage of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response at Week 16
PASI is a composite score based on the percentage of the body surface area (BSA) affected by psoriasis and the intensity of erythema (reddening), induration (thickening or hardening of the skin), and desquamation (peeling of the skin) of lesions assessed at 4 anatomic sites (head, upper extremities, trunk, and lower extremities). At each location, the percentage of BSA involvement is assigned a score from 0 (no involvement) to 6 (90% to 100% involvement), and erythema, induration, and desquamation are scored on a scale from 0 (no symptoms) to 4 (very marked). The PASI score ranges from 0 (no psoriasis) to 72 (very severe psoriasis). A PASI-75 response is the percentage of participants who achieved at least a 75% reduction (improvement) from Baseline in PASI score.
Time frame: Baseline and Week 16
Population: Full analysis set participants with Baseline psoriasis BSA involvement ≥ 3%; participants who prematurely discontinued from study drug prior to Week 16 or for whom PASI data were missing at Week 16 were considered non-responders.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response at Week 16 | 16.0 percentage of participants |
| Upadacitinib 15 mg | Percentage of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response at Week 16 | 52.3 percentage of participants |
| Upadacitinib 30 mg | Percentage of Participants Achieving Psoriasis Area Severity Index (PASI) 75 Response at Week 16 | 56.5 percentage of participants |
Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 2
Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR20 response criteria: 1. ≥ 20% improvement in 68-tender joint count; 2. ≥ 20% improvement in 66-swollen joint count; and 3. ≥ 20% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
Time frame: Baseline and Week 2
Population: Full analysis set; participants who prematurely discontinued from study drug prior to Week 2 or for whom ACR data were missing at Week 2 were considered non-responders.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 2 | 10.8 percentage of participants |
| Upadacitinib 15 mg | Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 2 | 32.7 percentage of participants |
| Upadacitinib 30 mg | Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 2 | 33.5 percentage of participants |
Percentage of Participants With an American College of Rheumatology 50% (ACR50) Response at Week 12
Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR50 response criteria: 1. ≥ 50% improvement in 68-tender joint count; 2. ≥ 50% improvement in 66-swollen joint count; and 3. ≥ 50% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
Time frame: Baseline and Week 12
Population: Full analysis set; participants who prematurely discontinued from study drug prior to Week 12 or for whom ACR data were missing at Week 12 were considered non-responders.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants With an American College of Rheumatology 50% (ACR50) Response at Week 12 | 4.7 percentage of participants |
| Upadacitinib 15 mg | Percentage of Participants With an American College of Rheumatology 50% (ACR50) Response at Week 12 | 31.8 percentage of participants |
| Upadacitinib 30 mg | Percentage of Participants With an American College of Rheumatology 50% (ACR50) Response at Week 12 | 37.6 percentage of participants |
Percentage of Participants With an American College of Rheumatology 70% (ACR70) Response at Week 12
Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR70 response criteria: 1. ≥ 70% improvement in 68-tender joint count; 2. ≥ 70% improvement in 66-swollen joint count; and 3. ≥ 70% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
Time frame: Baseline and Week 12
Population: Full analysis set; participants who prematurely discontinued from study drug prior to Week 12 or for whom ACR data were missing at Week 12 were considered non-responders.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants With an American College of Rheumatology 70% (ACR70) Response at Week 12 | 0.5 percentage of participants |
| Upadacitinib 15 mg | Percentage of Participants With an American College of Rheumatology 70% (ACR70) Response at Week 12 | 8.5 percentage of participants |
| Upadacitinib 30 mg | Percentage of Participants With an American College of Rheumatology 70% (ACR70) Response at Week 12 | 16.5 percentage of participants |