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 standard use of adalimumab plus continued low-dose methotrexate (MTX) [4]. Genovese et al. aimed to describe outcomes linked to treatment shift from upadacitinib to adalimumab and vice versa, in RA-patients who did not achieve remission or low disease activity [1].
The phase 3 SELECT-COMPARE trial was set up as a double-blind, placebo-controlled head-to-head study. A total of 1,629 patients ≥18 years old with moderate-to-severe RA and an inadequate response to methotrexate (MTX-IR) were randomly assigned to receive 15 mg/day oral upadacitinib (n=651), 40 mg adalimumab injections every other week (n=327), or placebo (n=651) in addition to background MTX.
Primary results showed that 126 (19%) patients receiving upadacitinib and 77 (24%) receiving adalimumab failed to achieve ≥20% improvement in either tender or swollen joint count by weeks 14, 18, or 22 and were switched without a wash-out period to receive the alternative drug treatment. The post-hoc analysis showed a potential benefit for switching between upadacitinib and adalimumab (see Table). Overall, data obtained after the switch to upadacitinib are consistent with data observed in a phase 3 study of upadacitinib in RA patients with inadequate response to bDMARDs [5].
Table: Primary endpoints at 6 months post-switch.
Patient proportion with infection and serious infection through 6 months after switching appeared consistent with those observed for adalimumab and upadacitinib during comparable months. No additional or unusual safety concerns were observed in either treatment group.
- Genovese M. et al. Abstract OP0029. EULAR 2019
- Nam JL, et al. Ann Rheum Dis, 2017;76:1113-36.
- Singh JA, et al. Arthritis Rheumatol. 2016 Jan;68(1):1-26.
- Fleischmann R, et al. Abstract 890. 2018 ACR/ARHP Annual Meeting.
- Genovese MC, et al. Lancet, 2018;391:2513-24.
Posted on
Previous Article
« Tapering of prednisone in RA patients who achieved low disease activity or remission with tocilizumab Next Article
Tofacitinib is safe according to real-world data analysis »
« Tapering of prednisone in RA patients who achieved low disease activity or remission with tocilizumab Next Article
Tofacitinib is safe according to real-world data analysis »
Table of Contents: EULAR 2019
Featured articles
Efficacy and safety of ixekizumab versus adalimumab in patients with PsA
Rheumatoid Arthritis
Cohort study shows improvement during 25 years of RA treatment
Filgotinib in RA patients with inadequate response or naïve to methotrexate
Clinical effectiveness of fenebrutinib in RA patients with methotrexate or TNFi failure
Short methotrexate stop is safe in patients with RA
Tofacitinib is safe according to real-world data analysis
Tapering of prednisone in RA patients who achieved low disease activity or remission with tocilizumab
Efficacy and safety of E6011 in RA patients with inadequate response to methotrexate
Preliminary efficacy and safety data of RG6125 in RA patients with an inadequate response to TNF inhibitors
Integrated 10-year analysis confirms safety profile abatacept
Switching among multiple infliximab biosimilars does not cause immunogenicity
Switch to sarilumab from adalimumab is efficacious and safe
Axial Spondyloarthritis
Treat-to-target approach emerging in axial spondyloarthritis
NSAIDs consumption is linked to patient-assessed disease activity and decreases with use of TNF inhibitors
Psoriatic Arthritis
Efficacy and safety of ixekizumab versus adalimumab in patients with PsA
Efficacy and safety of bimekizumab in patients with active PsA
Filgotinib is efficacious and safe in PsA
Ixekizumab improves signs and symptoms in TNFi-naïve PsA patients
Etanercept and methotrexate as first-line treatment in PsA
Unacceptable pain is common in patients with psoriatic arthritis
Osteoarthritis and Osteoporosis
Miscellaneous
Interstitial lung disease in rheumatic diseases and systemic sclerosis
Emapalumab in patients with macrophage activation syndrome
Support for tocilizumab use in giant cell arteritis
Related Articles
September 4, 2019
Treat-to-target approach emerging in axial spondyloarthritis
© 2024 Medicom Medical Publishers. All rights reserved. Terms and Conditions | Privacy Policy
HEAD OFFICE
Laarderhoogtweg 25
1101 EB Amsterdam
The Netherlands
T: +31 85 4012 560
E: publishers@medicom-publishers.com