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08-06-2020 | Rheumatology | News | Article

EULAR 2020

Upadacitinib outperforms abatacept in head-to-head RA trial

Author:
Laura Cowen

medwireNews: The Janus kinase (JAK)1 selective inhibitor upadacitinib improves disease activity to a greater degree than abatacept in rheumatoid arthritis (RA) patients with previous biologic exposure, show data presented at the EULAR 2020 E-Congress.

“SELECT-CHOICE is the first study demonstrating the superiority of a selective JAK inhibitor compared to a standard of care biologic in a population of RA patients with a prior inadequate response [IR] to a biologic therapy, and adds to the understanding of the benefit:risk profile of [upadacitinib] for the treatment of RA,” said Andrea Rubbert-Roth (Cantonal Clinic St Gallen, Switzerland) and co-authors in a poster presentation.

They found that the 303 patients with prior IR or intolerance to biologic DMARDs who were randomly assigned to receive once-daily oral upadacitinib 15 mg had an average 2.52-point reduction in DAS28-CRP after 12 weeks of treatment.

By comparison, the reduction was a significantly lower 2.00 points among the 309 patients randomly assigned to receive abatacept on day 1 and weeks 2, 4, 8, 12, 16, and 20 at a dose based on their weight (<60 kg: 500 mg; 60–100 kg: 750 mg; >100 kg: 1000 mg).

The 95% confidence intervals for the between-group difference of 0.52 points met the criteria for both non-inferiority and superiority, suggesting that upadacitinib is superior to abatacept in this setting, said the investigators.

In addition, significantly more participants achieved clinical remission (DAS28-CRP <2.6 points) with upadacitinib than with abatacept at week 12 (30 vs 13%) and week 24 (46 vs 31%).

And a similar pattern was observed for other outcome measures including low disease activity, ACR50 and ACR70 response rates, CDAI remission, and SDAI remission.

The researchers also recorded significantly greater improvements in some patient-reported outcomes in the upadacitinib versus abatacept arms. This included a higher proportion of patients achieving clinically meaningful change in HAQ-DI at week 12 and a greater improvement from baseline in the physical component summary of the SF-36 at weeks 12 and 24.

Of note, all study participants continued stable background treatment with conventional DMARDs, and from week 12 onward, those who did not achieve at least a 20% improvement from baseline in both tender and swollen joint counts at two consecutive visits had background medication adjusted or initiated.

Approximately two-thirds of patients had received one prior biologic DMARD, approximately 22% had received two, and around 10% had received three or more prior biologics.

Safety analyses did not identify any new risks associated with upadacitinib, but people receiving the JAK1 inhibitor had a higher incidence of serious treatment-emergent adverse events (AEs; 3.3 vs 1.6%), AEs leading to discontinuation (4.6 vs 2.9%), and hepatic disorders (7.6 vs 1.6%) thank those receiving abatacept.

There was one treatment-emergent death in the upadacitinib arm due to cardiac arrest after an initial hospitalization with pneumonia.

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

EULAR 2020 E-Congress; 3–6 June
Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-eular.2059

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