Long-term Efficacy and Safety Following Switch Between Upadacitinib and Adalimumab in Patients with Rheumatoid Arthritis: 5-Year Data from SELECT-COMPARE

Roy Fleischmann; Ricardo Blanco; Filip Van den Bosch; Louis Bessette; Yanna Song; Sara K Penn; Erin McDearmon-Blondell; Nasser Khan; Kelly Chan; Eduardo Mysler

doi:10.1007/s40744-024-00658-1

Long-term Efficacy and Safety Following Switch Between Upadacitinib and Adalimumab in Patients with Rheumatoid Arthritis: 5-Year Data from SELECT-COMPARE

Rheumatol Ther. 2024 Mar 18. doi: 10.1007/s40744-024-00658-1. Online ahead of print.

Authors

Affiliations

¹ Metroplex Clinical Research Center, University of Texas Southwestern Medical Center, 8144 Walnut Hill Lane, Suite 810, Dallas, TX, 75231, USA. rfleischmann@arthdocs.com.
² Rheumatology Division, Hospital University Marqués de Valdecilla, Immunopathology Group, IDIVAL, Santander, Spain.
³ VIB-UGent Center for Inflammation Research, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
⁴ Laval University, Rheumatology, QC, Canada.
⁵ AbbVie Inc, North Chicago, IL, USA.
⁶ Organizacion Medica de Investigación, Rheumatology, Buenos Aires, Argentina.

PMID: 38498140
DOI: 10.1007/s40744-024-00658-1

Abstract

Introduction: This study aimed to describe the long-term efficacy and safety of upadacitinib and adalimumab through 228 weeks following immediate switch to the alternate therapy with a different mechanism of action (MoA) in patients with rheumatoid arthritis (RA) not achieving treatment goals with their initial randomized therapy in the ongoing phase 3 SELECT-COMPARE study.

Methods: Patients with non-response or incomplete response to initially prescribed upadacitinib 15 mg once daily or adalimumab 40 mg every other week were switched to the alternate therapy by week 26. Efficacy was evaluated through 228 weeks post-switch using validated outcome measures, including Clinical Disease Activity Index (CDAI) low disease activity (LDA; ≤ 10)/remission (≤ 2.8); 28-joint Disease Activity Score based on C-reactive protein ≤ 3.2/< 2.6; ≥ 20%/50%/70% improvement in American College of Rheumatology (ACR) response criteria; and change from baseline in ACR core components. Data are reported as observed. Safety was assessed by treatment-emergent adverse events (TEAEs) through week 264.

Results: Of patients initially randomized to upadacitinib and adalimumab, 38.7% and 48.6%, respectively, switched to the alternate therapy by week 26. Clinically relevant improvements in all efficacy measures were observed through 228 weeks post-switch and were generally similar between groups, with small numeric differences mostly in favor of switching to upadacitinib. CDAI remission was achieved by 32.7% and 28.6% of initial non-responders, and 27.5% and 27.3% of incomplete responders, while CDAI LDA was achieved by 76.9% and 72.9% of non-responders, and 72.5% and 72.7% of incomplete responders switching to upadacitinib and to adalimumab, respectively. TEAE rates were similar between groups, although herpes zoster infection, lymphopenia, and creatine phosphokinase elevation were more frequent when switching to upadacitinib. No new safety signals were identified.

Conclusion: Switching to a different MoA may provide long-term benefit to patients with RA not achieving treatment goals with their initial therapy, with acceptable safety profiles.

Trial registration: NCT02629159.

Keywords: Adalimumab; Efficacy; JAK inhibitor; Long-term extension; Rheumatoid arthritis; TNF inhibitor; Treatment switch; Upadacitinib.

Associated data

ClinicalTrials.gov/NCT02629159