ORIGINAL RESEARCH article
Front. Med.
Sec. Rheumatology
Comparative Effectiveness of Upadacitinib vs Tofacitinib in Psoriatic Arthritis: A Multicenter Observational Study from the BIRRA Cohort
- AC
Alessandro Conforti 1
- MG
Martina Gentile 2
- VC
valerio cipolloni 1
- LL
Linda Lucchetti 3
- AB
Andrea Becciolini 4
- MP
Marta Priora 5
- EC
eleonora celletti 6
- MD
Miriam Di Penta 6
- AL
Alberto Lo Gullo 7
- MP
Marino Paroli 8
- EB
elena bravi 9
- RA
romina andracco 10
- VN
valeria nucera 11
- FO
Francesca Ometto 12
- FL
Federica Lumetti 13
- AF
Antonella Farina 14
- MC
Matteo Colina 15
- VR
viviana Ravagnani 16
- PS
Palma Scolieri 17
- ML
Maddalena Larosa 18
- EV
Elisa Visalli 19
- OA
Olga Addimanda 20
- RV
Rosetta Vitetta 21
- AV
Alessandro Volpe 22
- AB
Alessandra Bezzi 23
- FG
Francesco Girelli 24
- AB
Aldo Biagio Mollica Colella 25
- RC
Rosalba Caccavale 26
- ED
eleonora Di Donato 4
- GA
Giuditta Adorni 4
- DS
daniele santilli 4
- GL
gianluca lucchini 4
- EA
eugenio arrigoni 27
- ES
emanuela sabatini 28
- IP
ilaria platè 27
- NM
natalia mansueto 27
- AI
aurora iannello 11
- EF
Enrico Fusaro 29
- MC
Maria Chiara Ditto 29
- VB
vincenzo bruzzese 30
- DC
dario camellino 31
- GB
gerolamo bianchi 31
- FS
francesca serale 32
- RF
rosario foti 33
- GA
giorgio amato 33
- FD
Francesco De Lucia 33
- YD
ylenia dal bosco 33
- RF
Roberta Foti 33
- MR
massimo reta 20
- AF
alessia fiorenza 21
- GR
Guido Rovera 21
- AM
antonio marchetta 34
- MC
Maria Cristina focherini 23
- FM
fabio mascella 35
- SB
simone bernardi 36
- GS
Gilda Sandri 37
- DG
Dilia Giuggioli 38
- CS
Carlo Salvarani 38
- VF
veronica franchina 39
- FM
francesco molica colella 40
- GF
giulio ferrero 41
- MM
mirco magnani 20
- MM
marta maset 42
- CM
carolina mazzanti 43
- GS
gianluca santoboni 43
- CA
claudio angrisani 43
- MD
massimiliano de simone 43
- BR
Bernd Raffeiner 44
- SP
simone parisi 29
- AA
alarico ariani 20
1. Ospedale Civile San Paolo, Civitavecchia, Italy
2. Agenzia Sanitaria Locale Viterbo, Viterbo, Italy
3. Ospedale San Paolo ASL ROMA 4 , Pharmacology Unit, civitavecchia, Italy
4. Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
5. Rheumatology Day Hospital and Outpatient Clinic, ASL CN1, Cuneo, cuneo, Italy
6. Rheumatology Unit, Clinica Medica Institute, SS Annunziata Hospital, Chieti, chieti, Italy
7. UOSD Reumatologia Ospedale Papardo I, messina, Italy
8. Universita degli Studi di Roma La Sapienza, Rome, Italy
9. Rheumatology Unit, Ospedale G. Da Saliceto, Piacenza, Italy IT, piacenza, Italy
10. Imperia Hospital IT, imperia, Italy
11. ASL NO, Novara, Italy
12. Azienda ULSS 6 Euganea, Padua, Italy
13. Rheumatology Unit, Azienda USL of Modena and AOU Policlinico of Modena, modena, Italy
14. Internal Medicine Unit, Rheumatology Outpatient Clinic, Augusto Murri Hospital, Fermo, fermo, Italy
15. di Reumatologia, UOC Medicina Interna A, Dipartimento Medico-Oncologico, Ospedale Santa Maria della Scaletta, Imola, Bologna, Italy; Alma Mater Studiorum, (DIBIDEM), Università di Bologna, Italy, bologna, Italy
16. Ospedale Santa Chiara di Trento, Trento, Italy
17. Rheumatology Unit, Department of Medical Specialties, Nuovo Regina Margherita Hospital, Rome, rome, Italy
18. Division of Rheumatology, Department of Medical Specialties, La Colletta Hospital, ASL 3 Genova, genoa, Italy
19. Presidio Ospedaliero San Marco, Catania, Italy
20. IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola, Bologna, Italy
21. Presidio Ospedaliero Sant'Andrea di Vercelli, Vercelli, Italy
22. IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
23. Internal Medicine and Rheumatology Unit, ASL Romagna—Rimini, Rimini, rimini, Italy
24. Ospedale Morgagni-Pierantoni, Forli, Italy
25. Rheumatology Unit, Division of Internal Medicine, A.O. Papardo, Messina, messina, Italy
26. Universita degli Studi di Roma La Sapienza Dipartimento di Scienze Cliniche Internistiche Anestesiologiche e Cardiovascolari, Rome, Italy
27. Rheumatology Unit, Imperia Hospital, Imperia, imperia, Italy
28. Ospedale Policlinico SS Annunziata, Chieti, Italy
29. Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Turin, Italy
30. Poliambulatorio Nuovo Regina Margherita, Rome, Italy
31. Ospedale La Colletta, Genoa, Italy
32. Azienda Sanitaria Locale Roma 4, Civitavecchia, Italy
33. Azienda Ospedaliero Universitaria Policlinico G Rodolico San Marco, Catania, Italy
34. Ospedale Sacro Cuore Don Calabria Unita di Ginecologia, Negrar di Valpolicella, Italy
35. 22. Internal Medicine and Rheumatology Unit, ASL Romagna—Rimini, Rimini, rimini, Italy
36. 23. Rheumatology Unit, G.B. Morgagni—L. Pierantoni Hospital, Forlì, forlì, Italy
37. Rheumatology Unit, University of Modena and Reggio Emilia, Modena, modena, Italy
38. Universita degli Studi di Modena e Reggio Emilia, Modena, Italy
39. Medical Oncology Unit, A.O. Papardo, Messina, messina, Italy
40. Universita degli Studi di Milano-Bicocca, Milan, Italy
41. Ospedale Santa Corona Pietra Ligure, Pietra Ligure, Italy
42. Azienda ULSS n 1 Dolomiti, Belluno, Italy
43. Center for the Diagnosis and Therapy of Autoimmune Rheumatological Diseases, Viterbo, viterbo, Italy
44. UOC Reumatologia, Department of Rheumatology, Bolzano., bolzano, Italy
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Abstract
Background Real-world comparative data on the effectiveness and persistence of upadacitinib (UPA) and tofacitinib (TOFA) in psoriatic arthritis (PsA) remain limited. Objective This study aimed to compare real-world treatment persistence between upadacitinib (UPA) and tofacitinib (TOFA) in patients with psoriatic arthritis (PsA) and to identify predictors of discontinuation using data from the Italian multicenter BIRRA cohort. Methods In this retrospective, multicenter, observational study, PsA patients treated with UPA and/or TOFA were enrolled from 34 rheumatology centers. Baseline demographics, treatment details, and disease activity (DAPSA) were collected. Treatment persistence was evaluated using Kaplan-Meier survival analysis. Cox proportional hazards models identified predictors of discontinuation, including sex, age, treatment line, prescription year, concomitant csDMARDs/steroids, PsA subtype (peripheral, axial, or mixed), and prior or current JAK inhibitor (JAKi) use. Results Among 181 enrolled patients (UPA n=124; TOFA n=57), retention rates at 6, 12, and 18 months were 86%, 68%, and 54% for UPA and 78%, 60%, and 60% for TOFA (p=0.7). Concomitant csDMARD therapy (HR: 1.92; 95% CI: 1.04–3.54; p=0.037) and later-line treatment (HR: 1.17; 95% CI: 1.01–1.35; p=0.034) were independently associated with higher discontinuation risk. No statistically significant differences were observed between the two JAK inhibitors. Conclusion UPA demonstrated a slightly longer persistence than TOFA, though the difference was not statistically significant after adjustment. Concomitant csDMARDs and later treatment lines significantly reduced persistence. These results suggest that PsA treatment retention may be influenced more by patient- and treatment-related factors than by the specific JAK inhibitor prescribed.
Summary
Keywords
effectiveness, Observational studies, Psoriasic arthritis, tofacinib, upadacitin
Received
18 February 2026
Accepted
22 May 2026
Copyright
© 2026 Conforti, Gentile, cipolloni, Lucchetti, Becciolini, Priora, celletti, Di Penta, Lo Gullo, Paroli, bravi, andracco, nucera, Ometto, Lumetti, Farina, Colina, Ravagnani, Scolieri, Larosa, Visalli, Addimanda, Vitetta, Volpe, Bezzi, Girelli, Mollica Colella, Caccavale, Di Donato, Adorni, santilli, lucchini, arrigoni, sabatini, platè, mansueto, iannello, Fusaro, Ditto, bruzzese, camellino, bianchi, serale, foti, amato, De Lucia, dal bosco, Foti, reta, fiorenza, Rovera, marchetta, focherini, mascella, bernardi, Sandri, Giuggioli, Salvarani, franchina, molica colella, ferrero, magnani, maset, mazzanti, santoboni, angrisani, de simone, Raffeiner, parisi and ariani. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Alessandro Conforti
Disclaimer
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