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This retrospective, single-center study evaluated 52-week real-world effectiveness, persistence, and safety of the selective JAK1 inhibitor upadacitinib in 45 Turkish patients with prior TNFi failure. Outcomes included BASDAI, ASDAS, BASFI, BASMI, HAQ, pain VAS, and ASAS20/40/70 responses, alongside Kaplan–Meier persistence and adverse-event incidence.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/real-world-effectiveness-and-safety-of-upadacitinib-in-tumor-necrosis-factor-inhibitor-refractory-axial-spondyloarthritis-52-week-outcomes-from-a-single-center-cohort/407910/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/real-world-effectiveness-and-safety-of-upadacitinib-in-tumor-necrosis-factor-inhibitor-refractory-axial-spondyloarthritis-52-week-outcomes-from-a-single-center-cohort/407910.png","ImageObject",300,407,{"name":92,"@type":93},"Dipper","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is upadacitinib studied in TNFi-refractory axial spondyloarthritis?","Question",{"text":112,"@type":113},"Patients who fail TNFi represent a treatment-refractory subgroup, and real-world evidence for selective JAK1 inhibition in this setting has been limited.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What outcomes were assessed over 52 weeks?",{"text":117,"@type":113},"The study evaluated disease activity and function using BASDAI, ASDAS, BASFI, BASMI, HAQ, pain VAS, and ASAS20/40/70 response rates.",{"name":119,"@type":110,"acceptedAnswer":120},"How did safety and drug persistence look in the cohort?",{"text":121,"@type":113},"Upadacitinib showed favorable 1-year drug retention, while adverse events were infrequent and manageable; across 38.3 patient-years, no serious infections, malignancies, or thromboembolic events were observed.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},407910,1790716752,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},1374404997633,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","ORIGINAL ARTICLE  \nArchives of Rheumatology 2025;40(4):465-473 DOI: 10.5152/ArchRheumatol.2025.11098  \nReal-World Effectiveness and Safety of Upadacitinib in Tumor Necrosis FactorInhibitor Refractory Axial Spondyloarthritis:  \n52-Week Outcomes from a Single-Center Cohort  \nABSTRACT  \nBackground/Aims: Patients with axial spondyloarthritis (axSpA) who fail tumor necrosis factor inhibitors (TNFi) represent a treatment-refractory subgroup with limited options. Real-world evidence (RWE) on the effectiveness and safety of selective Janus kinase 1 (JAK1) inhibition in this setting remains scarce. This study aimed to evaluate the 52-week real-world effectiveness, persistence, and safety of upadacitinib in TNFi-refractory axSpA patients.  \nMaterials and Methods: In this retrospective, single-center study, 45 Turkish axSpA patients with prior TNFi failure received upadacitinib 15 mg daily and were assessed at weeks 12, 24, and 52. Effectiveness outcomes included Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Health Assessment Questionnaire (HAQ), Visual Analog Scale for pain, and Assessment of SpondyloArthritis International Society (ASAS) 20/40/70 responses analyzed with non-responder imputation (NRI) . Treatment persistence was evaluated by Kaplan–Meier analysis, predictors of discontinuation by Cox regression, and safety outcomes as incidence per 100 patient-years (PY) .  \nResults: Mean age was 48.1 years; 53.3% were male; 68.9% human leukocyte antigen B27 positive. At week 52, BASDAI and ASDAS decreased significantly (both P \u003C .001), with parallel improvements in BASFI, BASMI, HAQ, and pain. The ASAS20/40/70 responses were achieved by 75 .6%, 60.0%, and 26.7% of patients (NRI) . Drug retention was 75.6% at 1 year; discontinuations occurred due to adverse events (AEs) (4 .4%), treatment failure (11 .1%), patient decision (6 .7%), and pregnancy (2 .2%) . Prior interleukin-17 inhibitor (IL-17i) exposure (HR 3 . 88) and multiple TNFi use (HR 3 .02) predicted shorter drug survival. Across 38.3 PY, no serious infections, malignancies, or thromboembolic events were observed; AEs were infrequent and manageable.  \nConclusion: Upadacitinib provided sustained improvements in disease activity, function, and patient-reported outcomes inTNFi-refractory axSpA, with favorable persistence and safety. Despite limitations of the retrospective, single-center design and modest sample size, these findings complement pivotal trials and global real-world data and represent the first RWE of upadacitinib use in Türkiye, supporting JAK1 inhibition as a therapeutic option in difficult-to-treat populations.  \nKeywords: Axial spondyloarthritis, enthesitis, JAK inhibitors, real-world study, upadacitinib  \nCopyright@Author(s) -[Available online at archivesof rheumatology.com](Available online at archivesof rheumatology.com). Content of this journal is licensed under a Creative Commons Attribution (CC BY) 4.0 International License.  \nUmut Bakay1 Tuğba İzci Duran1  \n1Department of Rheumatology, Denizli State Hospital, Denizli, Türkiye  \nCorresponding author: Umut Bakay  \n􀀍 [ubakay280220@gmail.com](ubakay280220@gmail.com)  \nReceived: July 25, 2025  \nRevision Requested:  \nSeptember 21, 2025  \nLast Revision Received:  \nOctober 6, 2025  \nAccepted: October 14, 2025  \nPublication Date: December 1, 2025  \nCite this article as: Bakay U, Duran Tİ . Real-world effectiveness and safety of upadacitinib in tumor necrosis factor-inhibitor refractory axial spondyloarthritis: 52-week outcomes from a single-center cohort. Arch Rheumatol. 2025;40(4):465-473 .  \n465  \nArchives of Rheumatology 2025;40(4):465-473 Bakay and İzci Duran. Upadacitinib in TNFi-Refractory axSpA: A 52-Week R-WS  \nIntroduction  \nAxial spondyloarthritis (axSpA) is a chronic, immunemediated inflammatory disorder that predominantly involves ","cbCaicXT6Cw0pQOB","https://ap.wps.com/l/cbCaicXT6Cw0pQOB","pdf",610257,"English","# Abstract\n## Background/Aims\n## Materials and Methods\n## Results\n## Conclusion\n# Introduction\n## Disease background and epidemiology\n## Disease forms and treatment context\n# Main Points","[{\"question\":\"Why is upadacitinib studied in TNFi-refractory axial spondyloarthritis?\",\"answer\":\"Patients who fail TNFi represent a treatment-refractory subgroup, and real-world evidence for selective JAK1 inhibition in this setting has been limited.\"},{\"question\":\"What outcomes were assessed over 52 weeks?\",\"answer\":\"The study evaluated disease activity and function using BASDAI, ASDAS, BASFI, BASMI, HAQ, pain VAS, and ASAS20/40/70 response rates.\"},{\"question\":\"How did safety and drug persistence look in the cohort?\",\"answer\":\"Upadacitinib showed favorable 1-year drug retention, while adverse events were infrequent and manageable; across 38.3 patient-years, no serious infections, malignancies, or thromboembolic events were observed.\"}]","Real-World Effectiveness and Safety of Upadacitinib in Tumor Necrosis Factor-Inhibitor Refractory Axial Spondyloarthritis - 52-Week Outcomes from a Single-Center Cohort | PDF",1790576853,25]