AB0942 NOCICEPTIVE, NEUROPATHIC, AND NOCIPLASTIC COMPONENTS OF PAIN IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: BASELINE RESULTS FROM AN ONGOING OBSERVATIONAL STUDY
Authors: D. Poddubnyy, T. Gao, C. D. Saffore, D. Vassilopoulos, D. Wendling, A. Tran, F. Ganz
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that predominantly manifests with persistent pain in the back or peripheral joints. Pain in axSpA can be attributed to inflammation (nociceptive), peripheral nervous system damage (neuropathic), or altered central nervous system pain modulation/central sensitization (nociplastic), and significantly impacts patients' quality of life. [<sup>1,2]</sup> Upadacitinib, an oral Janus kinase inhibitor (JAKi), has shown efficacy, including pain reduction, in the phase 3 SELECT-AXIS programs. [<sup>3,4]</sup> However, its effectiveness must be evaluated in routine clinical practice and on different pain components. <h3>Objectives:</h3> Here we present an interim analysis of baseline data from the UPSTAND study (NCT04846244). <h3>Methods:</h3> UPSTAND is an ongoing multi-country, post-marketing, observational study evaluating the real-world effectiveness of upadacitinib on pain for up to 12 months. Eligible patients included in this analysis were aged ≥18 years, had a diagnosis of axSpA, prior inadequate response to ≥2 NSAIDs, and were prescribed upadacitinib in routine practice according to relevant approved licenses, with the decision to prescribe upadacitinib made prior to and independent of study enrolment. Patients with prior JAKi exposure, or diagnosed with fibromyalgia based on physician's clinical assessment, were not eligible. Data presented in this analysis include patient and disease characteristics at upadacitinib initiation (baseline), and are limited to descriptive data from 401 patients with radiographic axSpA (~50% of planned enrollment) collected during regular visits through May 10, 2023. Neuropathic and nociplastic pain components were evaluated using painDETECT and Widespread Pain Index/Symptom Severity Scale (WPI/SSS) scores, respectively. Quality of life was evaluated using Hospital Anxiety and Depression Scale, and Pittsburgh Sleep Quality Index. <h3>Results:</h3> At baseline, the mean patient age was 45.3 years, and 47.9% of patients were female (<b>Table 1</b>). Mean symptom duration was 13.7 years, and 3.0%, 11.6%, and 5.5% of patients had a history of uveitis, psoriasis, and inflammatory bowel disease, respectively. Approximately two-thirds of patients had elevated CRP (≥5.0 mg/L), indicating significant inflammatory activity at baseline (<b>Table 2</b>). The mean painDETECT score was 13.1, with 25.7% patients scoring ≥19, suggesting a probable neuropathic component. Potential presence of central sensitization based on WPI and SSS scores was found in 48.4% of patients based on diagnostic criteria used for fibromyalgia (WPI ≥7 and SSS ≥5 or WPI 3–6 and SSS ≥9). <sup>[5]</sup> <h3>Conclusion:</h3> In this study, patients with axSpA initiating upadacitinib treatment exhibited indicators of nociceptive (related to inflammation) and non-nociceptive (neuropathic, nociplastic) pain components, which may be relevant when predicting treatment response and will be further evaluated. <h3>REFERENCES:</h3> [1] Bidad K, et al. Nat Rev Rheumatol 2017;13:410–20 [2] Gok K, et al. J Clin Rheumatol 2018;24:324–7 [3] Van der Heijde D, et al. RMD Open 2022;8:e002280 [4] Deodhar A, et al. Lancet 2022;400:369–79 [5] Wolfe F, et al. J Rheumatol 2016;43:1743–8 <h3>Acknowledgements:</h3> AbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, review, and approval of the abstract. All authors had access to relevant data and participated in the drafting, review, and approval of this abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Katerina Betsista, MD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie. <h3>Disclosure of Interests:</h3> Denis Poddubnyy AbbVie, BMS, Eli Lilly, Janssen, Medscape, MSD, Novartis, Peervoice, Pfizer, and UCB, AbbVie, Biocad, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, MSD, Moonlake, Novartis, Pfizer, Samsung Bioepis, and UCB, AbbVie, Eli Lilly, MSD, Novartis, and Pfizer, Tianming Gao AbbVie, AbbVie, Christopher D. Saffore AbbVie, AbbVie, Dimitrios Vassilopoulos AbbVie, Eli Lilly, Genesis-Pharma, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, AbbVie, Eli Lilly, Genesis-Pharma, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, AbbVie, Eli Lilly, Genesis-Pharma, Janssen, MSD, Novartis, Pfizer, Roche, and UCB, Daniel Wendling: None declared, Ai Tran AbbVie, Novartis, and Pfizer, AbbVie, Novartis, and Pfizer, Fabiana Ganz former employee of AbbVie and may own AbbVie stock or options, former employee of AbbVie and may own AbbVie stock or options.