Findings from the prospective, multicenter CLOSE-UP study presented at ACR Convergence 2025 support the real-world effectiveness and safety of upadacitinib (UPA) in Canadian patients with moderate-to-severe rheumatoid arthritis (RA), including those with prior exposure to biologic or targeted synthetic DMARDs.

A total of 412 patients were enrolled and treated with UPA 15 mg once daily, with follow-up extending to 24 months. Participants were stratified into 3 groups based on prior treatment: bio-naïve (47.1%), bio-experienced (41.3%), and tsDMARD-inadequate response (10.7%).

At baseline, 84.5% of patients had a DAS28-CRP > 3.2. By 6 months, 60.7% achieved the primary endpoint of DAS28-CRP < 2.6, and 75.6% reached low disease activity (DAS28-CRP ≤ 3.2). Clinical response was sustained through 24 months and consistent across all treatment history groups.

“The type of prior/most recent DMARD exposure did not impact response rates,” the authors reported. Additionally, response rates were similar for UPA monotherapy (62.7%) and UPA combined with csDMARDs (60.1%), suggesting flexibility in treatment approaches.

Patients also reported improvements in pain, fatigue, and physical function, with 86.5% remaining on UPA at 6 months and 67.5% at 24 months. “The safety profile of UPA was consistent with that seen in Phase 3 trials with no new safety signals,” the authors concluded.

For rheumatologists, these data reinforce upadacitinib’s role as a viable and durable option for patients across multiple lines of therapy, including those with prior inadequate response to biologics or tsDMARDs. The consistent outcomes across monotherapy and combination regimens provide further support for personalized treatment strategies in real-world practice.

Reference
Bessette L, Chow A, Rai R, et al . Effectiveness of upadacitinib in patients with rheumatoid arthritis in Canadian real-world practice: final results from the CLOSE-UP post-marketing observational study [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/effectiveness-of-upadacitinib-in-patients-with-rheumatoid-arthritis-in-canadian-real-world-practice-final-results-from-the-close-up-post-marketing-observational-study/