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Immediate switch between upadacitinib and adalimumab benefits RA nonresponders

Publish date:: December 7, 2020

Key clinical point: Rheumatoid arthritis patients who failed to respond to upadacitinib (Rinvoq) or adalimumab showed improvements in disease activity after switching to the other drug.

Major finding: At 6 months after switching drugs, low disease activity based on the Clinical Disease Activity Index occurred in 36% and 47% of nonresponders switched to adalimumab and upadacitinib, respectively, and in 45% and 58% of incomplete responders switched to adalimumab and upadacitinib, respectively.

Study details: The data come from a randomized trial of 651 patients given 15 mg of upadacitinib, 651 given a placebo, and 327 given 40 mg of adalimumab every other week for 26 weeks.

Disclosures: The study was funded by AbbVie. Lead author Dr. Fleischmann and coauthors disclosed relationships with multiple companies, including AbbVie, Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, EMD-Serono, Genentech, Gilead, Janssen, Novartis, Pfizer, Regeneron, Roche, Sanofi-Aventis, UCB, and Viela.

Commentary

“In implementing a treat to target strategy for patients with RA, therapy is adjusted (escalated or switched) if a patient’s disease activity has not reached optimal levels (low disease activity or remission). 1629 patients were randomized to receive upadicitinib, adalimumab, or placebo in combination with methotrexate, and therapy was switched after 14-22 weeks for patients not in low disease activity or remission states. The study, sponsored by Abbvie, found that 36% and 47% of nonresponders and 45% and 58% of incomplete responders switched to adalimumab and upadacitinib, respectively, achieved low disease activity based on CDAI; similar improvements were seen with other measures of disease activity and function. Some patients did have worsening of disease activity after switching therapy, and about 20% were “double non-responders.” While the study does not lend guidance on how to choose the next therapy for patients not responding to initial treatment, it does provide further support for the treat to target strategy; switching therapy has a reasonable likelihood of success.”