Upadacitinib and adalimumab switching beneficial in refractory RA
medwireNews: Patients with rheumatoid arthritis (RA) who initially fail to respond to either the Janus kinase (JAK) inhibitor upadacitinib or the tumor necrosis factor inhibitor adalimumab can benefit from switching to the alternative drug, post-hoc analysis of the SELECT-COMPARE study suggests.
Presenting the findings at the at the EULAR 2019 congress in Madrid, Spain, Mark Genovese (Stanford University, Palo Alto, California, USA) reported that many of the patients went “on to reach appropriately defined treatment goals and realize meaningful improvements in both clinical symptoms, function, and pain.”
For the initial study, 1629 patients with moderate-to-severe RA and an inadequate response to methotrexate were randomly assigned to receive oral upadacitinib 15 mg/day (n=651), adalimumab 40 mg injections every other week (n=327), or placebo (n=651) in addition to background methotrexate.
Of these, 126 (19%) receiving upadacitinib and 77 (24%) receiving adalimumab failed to achieve at least a 20% improvement in either tender joint count or swollen joint count by weeks 14, 18, or 22 and were switched without a washout period to receive the alternative drug treatment.
The post-hoc analysis showed that in the 6 months after switching, 35% of patients switched to adalimumab achieved a DAS28-CRP score of 3.2 or below, as did 54% of those switched to upadacitinib. Similarly, a CDAI score of 10 or below – indicating low disease activity – was achieved by 36% and 47% of patients, respectively.
When the team looked at these disease activity measures in association with remission, they found that 19% of patients switched to adalimumab and 31% of those switched to upadacitinib achieved a DAS28-CRP score below 2.6, while a respective 5% and 14% achieved a CDAI score of 2.8 or below.
Genovese highlighted that improvements on these measures occurred over the first 24 weeks after switching.
Function and pain also improved in the 24 weeks following switching, with an average HAQ-DI decrease from baseline of 0.52 for patients switched to adalimumab and 0.67 for those switched to upadacitinib and a respective decrease in pain score of 26.5 and 34.6 points.
Genovese noted that “despite an immediate switch without washout in monoclonal antibody, there were no additional or unusual safety concerns observed in either treatment group.” The adverse events were “roughly similar” in the two groups and there were no “no meaningful differences” during the first 3 months or at 6 months.
He summed up that based on the data “patients with an initial, inadequate, or nonresponse to either upadacitinib or adalimumab benefited from switching to the alternative therapy,” adding that, importantly, responses to upadacitinib in patients failing adalimumab were “consistent with what we saw in the overall upadacitinib results in the in the SELECT BEYOND trial.”
By Lucy Piper
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