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Upadacitinib is Superior to Methotrexate in Early RA

Aug 17, 2020 10:51 pm

In a head-to-head trial against methotrexate, JAK1 inhibition with upadacitinib was shown to be more effective in early, DMARD-naive rheumatoid arthritis (RA) patients.

The SELECT‐EARLY trial compared 24 week outcomes in 947 early RA patients treated with either daily upadacitinib (15mg or 30mg) or weekly methotrexate. The co-primary endpoints were:the ACR50 response at Week 12, and DAS28-CRP <2.6 (remission) at Week 24. The primary results are shown below.

  UPA 15mg UPA 30 mg MTX 
ACR50 @wk 12 52% 56% 28%
DAS-CRP <2.6 @ wk 24 48% 50% 19%

The week 24 ACR20 responses also favored UPA (78%, 79%) over MTX (58%). These statistically significant clinical outcomes were mirrored by other patient‐reported outcomes (e.g., HAQ, SF-36, FACIT-F). Moreover, greater radiographic protection was seen with UPA (compared to MTX) with 88% and 89% of upadacitinib treated patients showing no radiographic progression (mTSS ≤0) versus 78% with methotrexate ( P<0.01).

No new safety signals were identified, and deaths in the trial were rare and evenly distributed (2 UPA 15mg; 3 upadacitinib 30mg; and 1 methotrexate).

These clinical trial data show the superiority of UPA over MTX and confirm little added efficacy for the UPA 30 mg, over the UPA 15 mg dose.

The author has received compensation as an advisor or consultant on this subject

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