Upadacitinib in Rheumatoid Arthritis After Prior TNF Inhibitor Failure: A 12-Month Multicenter Real-World Study.

Objective: Patients with rheumatoid arthritis who do not achieve an adequate response to tumor necrosis factor inhibitors remain difficult to manage in routine clinical practice. Data from daily clinical care regarding selective JAK1 inhibition in this setting are limited. This study aimed to evaluate the 12-month effectiveness and safety of upadacitinib in Turkish patients with rheumatoid arthritis and previous tumor necrosis factor inhibitor failure. Materials and Methods: This retrospective multicenter study included adult patients with rheumatoid arthritis treated at two tertiary rheumatology centers who initiated upadacitinib at a dose of 15 mg/day after the failure of at least one tumor necrosis factor inhibitor. Disease activity, inflammatory markers, and functional status were assessed at baseline and at 3, 6, and 12 months using validated composite indices and patient-reported outcome measures. Changes over time were analyzed using repeated-measures statistical methods. Safety outcomes were collected from routine clinical follow-up records. Results: Forty patients were included in the analysis, with a mean age of 48.4 years, and 62.5% were female. Consistent improvements were observed across disease activity measures throughout follow-up. At month 12, ACR20/50/70 response rates reached 87.5%, 77.5%, and 40.0%, respectively. Additionally, 45.0% of patients achieved low disease activity or remission according to the SDAI. Functional status improved in parallel with reductions in inflammatory and clinical parameters. No serious adverse events were observed during the 12-month follow-up, while the reported adverse events were mild. Conclusion: Upadacitinib demonstrated sustained effectiveness and acceptable tolerability in patients with rheumatoid arthritis who had previously failed tumor necrosis factor inhibitor therapy in routine clinical practice.