Efficacy and Safety of Upadacitinib for Axial Spondyloarthritis: A Systematic Review and Meta-Analysis

Background Upadacitinib has been proved for the treatment of axial spondyloarthritis.However,the efficacy and the safety remain unclear.To assess the efficacy and safety of upadacitinib,a Janus 1 kinase inhibitor,in patients diagnosed with axial spondylarthritis,we conducted a systematic review and meta-analysis of randomized controlled trials.Methods A comprehensive search was performed across several databases,including PubMed,Web of Science,Scopus,ClinicalTrials.Gov,and the Cochrane Library,to identify randomized placebo-controlled trials that compared upadacitinib with placebo.The analysis focused on the efficacy and safety data derived from clinical trials involving upadacitinib at a dosage of 15 mg specifically for the treatment of axial spondylarthritis.Results A total of 3 trials involving 920 patients were included.The use of upadacitinib was associated with increased rates of achieving an ASAS40 response compared with placebo(OR 3.24;95%CI 2.43-4.33;p-value<0.00001).ASAS20 response,ASAS PR,and BASDAI50 were higher in the upadacitinib group than in the placebo group.However,the incidence of adverse events(OR 1.85;95%CI 0.78-4.35;p-value 0.16)and serious adverse events(OR 2.79;95%CI 0.88-8.84;p-value 0.08),did not differ between the upadacitinib and placebo groups.There were no significant differences between the two groups in terms of infection and liver dysfunction.Conclusions Upadacitinib was effective in active axial spondylarthritis patients and datas from this analysis demonstrate that upadacitinib is generally well tolerated.These findings support the further investigation of upadacitinib for the treatment of axial spondyloarthritis.