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Safety and effectiveness of upadacitinib or adalimumab plus methotrexate in patients with rheumatoid arthritis over 48 weeks with switch to alternate therapy in patients with insufficient response

Author

Fleischmann RM1, Genovese MC2, Enejosa JV3, Mysler E4, Bessette L5,6, Peterfy C7, Durez P8, Ostor A9, Li Y10, Song IH3. Ann Rheum Dis. 2019 Jul 30. pii: annrheumdis-2019-215764. doi: 10.1136/annrheumdis-2019-215764. [Epub ahead of print]

Author Information

1 Medicine, University of Texas Southwestern, Dallas, Texas, USA rfleischmann@arthdocs.com.

2 Rheumatology, Stanford University, Palo Alto, California, USA.

3 Immunology Clinical Development, Abbvie Inc, North Chicago, Illinois, USA.

4 Organización Medica de Investigación, Buenos Aires, Argentina.

5 Universite Laval Faculte de medecine, Quebec City, Quebec, Canada.

6 Centre de recherche du CHU de Québec, Université Laval, Quebec City, Québec, Canada.

7 Spire Sciences Inc, Boca Raton, Florida, USA.

8 Pôle de Recherche en Rhumatologie, Institut de Recherche Experimentale et Clinique, Universitde Louvain, UCL, Brussels, Belgium.

9 Cabrini Medical Center, Malvern, Victoria, Australia.

10 Data and Statistical Sciences, AbbVie Inc, North Chicago, Illinois, USA.

Abstract

BACKGROUND: 

In SELECT-COMPARE, a randomised double-blind study, upadacitinib 15 mg once daily was superior to placebo or adalimumab on background methotrexate (MTX) for treating rheumatoid arthritis signs and symptoms and inhibited radiographical progression versus placebo at 26 weeks. Here we report 48-week safety and efficacy in patients who continued their original medication or were rescued to the alternative medication for insufficient response.

METHODS: 

Patients on MTX received upadacitinib 15 mg, placebo or adalimumab for 48 weeks. Rescue without washout, from placebo or adalimumab to upadacitinib or upadacitinib to adalimumab occurred if patients had <20% improvement in tender joint count (TJC) or swollen joint count (SJC) (weeks 14/18/22) or Clinical Disease Activity Index (CDAI) >10 (week 26); remaining placebo patients were switched to upadacitinib at week 26. Efficacy was analysed by randomised group (non-responder imputation), as well as separately for rescued patients (as observed). Treatment-emergent adverse events per 100 patient-years were summarised.

RESULTS: 

Consistent with responses through week 26, from weeks 26 to 48, responses by randomised group including low disease activity, clinical remission and improvements in pain and function remained superior for upadacitinib versus adalimumab; radiographical progression remained lower for upadacitinib versus placebo (linear extrapolation). Although both switch groups responded, a higher proportion of patients rescued to upadacitinib from adalimumab achieved CDAI ≤10 at 6 months postswitch versus patients rescued from upadacitinib to adalimumab. Safety at week 48 was comparable to week 26.

CONCLUSION: 

Upadacitinib+MTX demonstrated superior clinical and functional responses versus adalimumab+MTX and maintained inhibition of structural damage versus placebo+MTX through week 48. Patients with an insufficient response to adalimumab or upadacitinib safely achieved clinically meaningful responses after switching to the alternative medication without washout.