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Switching upadacitinib and adalimumab is beneficial in refractory RA

EULAR 2019
Rheumatoid arthritis (RA) patients with an initial, inadequate response to either the Janus kinase (JAK) inhibitor upadacitinib or the TNF inhibitor (TNFi) adalimumab can benefit from switching to the alternative therapy. The first results showing the effectiveness of a TNFi following failure of a JAK inhibitor were presented [1]. Currently, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) are well established as first-line treatments for RA-patients; however, not all patients benefit. If remission or low disease activity with csDMARDs is not achieved, therapy with a biological DMARD, TNFi, or JAK inhibitor is recommended [2,3]. While data shows that patients regularly switch from bDMARD to JAK treatments, there is a lack of evidence for patients with inadequate response to a JAK inhibitor switching to a bDMARD. Recently, the JAK1-selective inhibitor upadacitinib demonstrated superior efficacy through 26 weeks compared with the stand...

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