Upadacitinib Tops Abatacept for RA Refractory to DMARDs

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by Healthday

Superior for mean change in composite DAS28-CRP values and remission, but more adverse events seen

FRIDAY, Oct. 16, 2020 (HealthDay News) — Upadacitinib is superior to abatacept for patients with rheumatoid arthritis refractory to biologic disease-modifying antirheumatic drugs (DMARDS), according to a study published online Oct. 15 in the New England Journal of Medicine.

Andrea Rubbert-Roth, M.D., from Cantonal Clinic St. Galen in Switzerland, and colleagues conducted a 24-week phase 3 trial involving patients with rheumatoid arthritis refractory to DMARDs. Patients were randomly assigned to receive either oral upadacitinib or intravenous abatacept, each in combination with stable synthetic DMARDS (303 and 309 patients, respectively).

The researchers found that from baseline, mean change in the composite Disease Activity Score for 28 joints based on the C-reactive protein level at week 12 was −2.52 and −2.00, respectively, in the upadacitinib and abatacept groups (difference, −0.52 points; 95 percent confidence interval, −0.69 to −0.35; P < 0.001 for noninferiority; P < 0.001 for superiority). Remission occurred in 30.0 and 13.3 percent of patients receiving upadacitinib and abatacept, respectively (difference, 16.8 percentage points; 95 percent confidence interval, 10.4 to 23.2; P < 0.001 for superiority). During the treatment period, in the upadacitinib group, there was one death, one nonfatal stroke, and two venous thromboembolic events; more patients in the upadacitinib group had elevated hepatic aminotransferase levels than patients in the abatacept group.

“Additional data from longer and larger trials are needed to better understand long-term outcomes and safety of upadacitinib as compared with other drugs for the treatment of rheumatoid arthritis,” the authors write.

Several authors disclosed ties to the pharmaceutical industry, including AbbVie, which manufactures upadacitinib and funded the study.

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