Background: Patients (pts) with rheumatoid arthritis (RA) are at an increased risk for the development of venous thromboembolism (VTE, including pulmonary embolism [PE] and deep vein thrombosis [DVT]) vs the general population (~2-fold increase).1 Beyond RA, additional risk factors have been described, with prior history of VTE and obesity posing particular risk. VTE events have been observed in pts receiving JAK inhibitors, including upadacitinib (UPA).
Objectives: To describe the incidence of VTE in pts with RA receiving UPA relative to active comparators in the phase 3 clinical trial program and to evaluate potential risk factors.
Methods: Adjudicated events of treatment-emergent VTE were determined in pts receiving UPA in an integrated analysis (data cut-off, 30 Jun 2019) of five randomized phase 3 trials (SELECT-EARLY, SELECT-MONOTHERAPY, SELECT-NEXT, SELECT-COMPARE, and SELECT-BEYOND), of which 4 evaluated both the UPA 15 mg and 30 mg QD doses and 1 (SELECT-COMPARE) evaluated only UPA 15. Incidence of VTE was also determined in pts receiving adalimumab (ADA) + methotrexate (MTX) in SELECT-COMPARE and MTX monotherapy in SELECT-EARLY. Events are attributed to treatment received at time of event and are summarized per events/100 patient yrs. VTE risk factors were assessed using univariate Cox regression models.
Results: A total of 35 VTE events were observed across treatment groups. The exposure-adjusted treatment-emergent event rates (E/100 PYs, 95% CI) of VTE were 0.5 (0.3, 0.7) for UPA 15, 0.3 (0.1, 0.7) for UPA 30, 0.5 (0.1, 1.3) for ADA + MTX, and 0.4 (0.1, 1.6) for MTX, with no pattern to event onset across treatments. Events of PE, DVT, or both PE and DVT were reported across treatment groups (Table). Pts who experienced VTE, across all treatment groups, on average, were older than pts who did not (62/59/58/61 yrs vs 54/55/54/53 yrs for UPA 15, UPA 30, ADA + MTX, and MTX, respectively). The mean body mass index (BMI) of pts with VTE tended to be higher (34–40 for pts with VTE vs 28-29 kg/m2 for those without). Across UPA treatment groups, 135/2629 (UPA 15) and 62/1204 (UPA 30) pts had a prior history of VTE; of these pts, 5 (3.7%) and 2 (3.2%) experienced VTE on UPA 15 and UPA 30, respectively. Univariate Cox regression models identified BMI and prior history of VTE as factors associated with VTE in the UPA 15 and 30 mg groups (Figure). Age and NSAID use were shown to be associated with VTE risk among pts in the UPA 15 but not 30 mg group.
Conclusion: VTE event rates appeared balanced across UPA doses and active comparator groups in pts with RA. Risk factors for VTE events identified through univariate analyses in pts who received UPA included prior history of VTE and BMI, two factors previously known to be associated with VTE risk. One limitation is the small sample size, limiting the analysis to univariate. Continued follow-up of pts receiving UPA is ongoing to further contextualize the risk of VTE in the clinical trial program.
References: Kim SC, et al. Arthritis Care Res 2013;65:1600-7.
Disclosure of Interests: Ernest Choy Grant/research support from: Amgen, Bio-Cancer, Chugai Pharma, Ferring Pharmaceuticals, Novimmune, Pfizer, Roche, UCB, Consultant of: AbbVie, Amgen, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Chelsea Therapeutics, Chugai Pharma, Daiichi Sankyo, Eli Lilly, Ferring Pharmaceuticals, GlaxoSmithKline, Hospita, Ionis, Janssen, Jazz Pharmaceuticals, MedImmune, Merck Sharp & Dohme, Merrimack Pharmaceutical, Napp, Novartis, Novimmune, ObsEva, Pfizer, R-Pharm, Regeneron Pharmaceuticals, Inc., Roche, SynAct Pharma, Sanofi Genzyme, Tonix, UCB, Speakers bureau: Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai Pharma, Eli Lilly, Hospira, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Sanofi-Aventis, UCB, Iain McInnes Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB, John Cush Grant/research support from: AbbVie, Astra Zeneca, Aurinia, Bristol-Myers Squibb, Genentech, Novartis, Pfizer, Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Boehringer-Ingelheim, Genentech, Gilead, Eli Lilly, Novartis and UCB, Jacob Aelion Grant/research support from: AbbVie, Ardea Biosciences, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Galapagos, GlaxoSmithKline, Janssen, Eli Lilly, Merck, Mesoblast, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi-Aventis, Takeda, and UCB Pharma, Consultant of: AbbVie, Boehringer Ingelheim, Celgene, and Eli Lilly, William Rigby Grant/research support from: Bristol-Myers Squibb, Consultant of: AbbVie, Bristol-Myers Squibb, Genentech, Pfizer, Yanna Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Sebastian Meerwein Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jianzhong Liu Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Nasser Khan Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Jessica Suboticki Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Alexander Cohen Consultant of: AbbVie, Apalgon, Aspen, BMS, Pfizer, Bayer, Daiichi Sankyo, Boehringer Ingelheim, Boston Scientific, Janssen, Portola
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