Upadacitinib vs Adalimumab for Rheumatoid Arthritis

(SELECT- SWITCH Trial)

Recruiting in Palo Alto (17 mi)

+274 other locations

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 3

Recruiting

Sponsor: AbbVie

Must be taking: Methotrexate

Must not be taking: JAK inhibitors

Disqualifiers: Juvenile arthritis, Non-RA inflammatory joint, others

No Placebo Group

Pivotal Trial (Near Approval)

Prior Safety Data

Trial Summary

What is the purpose of this trial?

This trial is testing two medications, upadacitinib (a daily pill) and adalimumab (an injection), for adults with rheumatoid arthritis who haven't responded to other treatments. The study aims to see which drug is safer and more effective. Both medications work by reducing inflammation through different mechanisms in the immune system. Adalimumab, an injection, has been extensively studied and used for treating rheumatoid arthritis, showing significant improvements in patients who have not responded to other treatments.

Will I have to stop taking my current medications?

The trial requires participants to stay on a stable dose of methotrexate (MTX) throughout the study. The protocol does not specify if you need to stop other medications, but you must have been treated with a TNF inhibitor for at least 3 months before joining.

What data supports the effectiveness of the drug Upadacitinib for treating rheumatoid arthritis?

Research shows that Upadacitinib, a drug taken by mouth, helps improve how patients with rheumatoid arthritis feel and function, especially when other treatments haven't worked well. It has been approved for use in the USA based on positive results from large studies. ^{1 2 3 4 5}

Is Upadacitinib safe for humans?

Upadacitinib has been shown to be generally safe in humans, but it may increase the risk of serious infections, herpes zoster (shingles), and elevated creatine phosphokinase levels. These risks are similar to those of other treatments like methotrexate and adalimumab, and its safety continues to be monitored in long-term studies. ^{3 6 7 8 9}

How does the drug upadacitinib differ from other treatments for rheumatoid arthritis?

Upadacitinib is unique because it is an oral medication that works by inhibiting Janus kinase 1 (JAK-1), a protein involved in inflammation, and has shown superior effectiveness compared to adalimumab when used with methotrexate in patients with rheumatoid arthritis who do not respond well to methotrexate alone. ^{3 8 10 11 12}

Research Team

ABBVIE INC.

Principal Investigator

AbbVie

Eligibility Criteria

Adults with moderate to severe Rheumatoid Arthritis (RA) who haven't responded well or are intolerant to one TNF-inhibitor, excluding adalimumab. They must have been on a stable methotrexate dose for at least 3 months and meet specific criteria for joint swelling, tenderness, and inflammation levels. Not eligible if they've used adalimumab before, other non-TNF biologic treatments, had arthritis before age 17, or taken any JAK inhibitors.

Inclusion Criteria

I have 6 or more swollen and tender joints and high levels of inflammation.

I have been diagnosed with Rheumatoid Arthritis for 3 months or more.

I have RA and have been treated with a TNFi for 3 months or more but still have active symptoms, or I couldn't tolerate the TNFi.

Exclusion Criteria

I have previously taken medication that targets JAK enzymes.

I have previously taken adalimumab.

I have previously used a non-TNFi biologic drug for my rheumatic disease.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment Period 1

Participants receive either oral upadacitinib once daily and matching adalimumab placebo every other week, or subcutaneous adalimumab every other week and matching upadacitinib placebo once daily

12 weeks

Regular visits at a hospital or clinic

Treatment Period 2

Eligible participants continue to receive the same study treatment as assigned in Period 1

12 weeks

Regular visits at a hospital or clinic

Follow-up

Participants are monitored for safety and effectiveness after treatment

10 weeks

Treatment Details

Interventions

• Adalimumab (Tumor Necrosis Factor (TNF) Inhibitor)
• Upadacitinib (Janus Kinase (JAK) Inhibitor)

Trial Overview The trial is testing the safety and effectiveness of oral Upadacitinib against subcutaneous Adalimumab in RA patients. It's double-blinded and randomizes participants into two groups: one receives Upadacitinib with placebo injections; the other gets Adalimumab with placebo pills. The study spans across approximately 250 sites worldwide with about 480 participants.

Participant Groups

Group I: Upadacitinib+ Adalimumab matching Placebo Experimental Treatment 2 Interventions

Participants will receive upadacitinib once a day along with matching placebo for adalimumab at eow (every other week) in Period 1. Eligible participants will continue to receive same study treatment in Period 2 as assigned in Period 1.

Group II: Adalimumab + Upadacitinib matching Placebo Experimental Treatment 2 Interventions

Participants will receive adalimumab at eow (every other week) along with matching placebo for upadacitinib once a day in Period 1. Eligible participants will continue to receive same study treatment in Period 2 as assigned in Period 1.

Adalimumab is already approved in Canada, Japan for the following indications:

Approved in Canada as Humira for:

• Rheumatoid arthritis
• Psoriatic arthritis
• Ankylosing spondylitis
• Crohn's disease
• Ulcerative colitis
• Plaque psoriasis
• Juvenile idiopathic arthritis

Approved in Japan as Humira for:

• Rheumatoid arthritis
• Psoriatic arthritis
• Ankylosing spondylitis
• Crohn's disease
• Ulcerative colitis
• Plaque psoriasis
• Juvenile idiopathic arthritis

Who Is Running the Clinical Trial?

AbbVie

Lead Sponsor

Trials

1,079

Recruited

535,000+

Founded

2013

Headquarters

North Chicago, USA

Known For

Immunology treatments

Top Products

Humira (adalimumab), Skyrizi (risankizumab), Rinvoq (upadacitinib)

Dr. Roopal Thakkar

AbbVie

Chief Medical Officer since 2023

MD from Wayne State University School of Medicine

Robert A. Michael

AbbVie

Chief Executive Officer

Bachelor's degree in Finance from the University of Illinois

Findings from Research

In a 48-week study involving patients with rheumatoid arthritis who did not respond adequately to methotrexate, upadacitinib showed significant improvements in patient-reported outcomes compared to placebo and was at least as effective as adalimumab.

Patients treated with upadacitinib reported greater reductions in pain, disability, and stiffness, with more individuals achieving clinically meaningful improvements across various measures compared to those on adalimumab.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Upadacitinib improves patient-reported outcomes vs placebo or adalimumab in patients with rheumatoid arthritis: results from SELECT-COMPARE. Strand, V., Tundia, N., Bergman, M., et al.[2022]

In a phase 3 trial involving patients with psoriatic arthritis who did not respond to previous treatments, upadacitinib showed significant improvements in patient-reported outcomes (PROs) compared to placebo and was as effective as adalimumab, particularly in measures like the Health Assessment Questionnaire Disability Index (HAQ-DI) and the SF-36 Physical Component Summary score.

Patients treated with upadacitinib experienced rapid improvements in symptoms as early as week 2, with sustained benefits observed through week 56, indicating its efficacy in enhancing quality of life for those with psoriatic arthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improvement in Patient-Reported Outcomes in Patients with Psoriatic Arthritis Treated with Upadacitinib Versus Placebo or Adalimumab: Results from SELECT-PsA 1. Strand, V., Mease, PJ., Soriano, ER., et al.[2022]

Upadacitinib, an oral JAK-1 inhibitor, received marketing approval in the USA in August 2019 for treating moderately to severely active rheumatoid arthritis after showing positive results in multinational phase III trials.

The approval was specifically for patients who had an inadequate response or intolerance to methotrexate, highlighting its role as an effective alternative treatment option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Upadacitinib: First Approval. Duggan, S., Keam, SJ.[2020]

In a study of 498 patients with rheumatoid arthritis who did not respond adequately to biologic treatments, both doses of upadacitinib (15 mg and 30 mg) significantly improved patient-reported outcomes (PROs) such as pain, disability, and overall disease activity compared to placebo.

More patients taking upadacitinib reported clinically meaningful improvements in quality of life measures, with the number needed to treat (NNT) to achieve these improvements ranging from 4 to 7, indicating that upadacitinib is effective in enhancing the well-being of patients with rheumatoid arthritis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of upadacitinib on patient-reported outcomes: results from SELECT-BEYOND, a phase 3 randomized trial in patients with rheumatoid arthritis and inadequate responses to biologic disease-modifying antirheumatic drugs. Strand, V., Schiff, M., Tundia, N., et al.[2023]

In a study involving 661 patients with rheumatoid arthritis (RA) who did not respond adequately to conventional DMARDs, upadacitinib (15 mg and 30 mg) significantly improved patient-reported outcomes such as pain, physical function, and overall disease activity after 12 weeks compared to placebo.

Patients taking upadacitinib reported clinically meaningful improvements in various measures, with the number needed to treat (NNT) for these benefits ranging from 4 to 8, indicating that a small number of patients need to be treated for one to experience significant improvement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Upadacitinib improves patient-reported outcomes in patients with rheumatoid arthritis and inadequate response to conventional synthetic disease-modifying antirheumatic drugs: results from SELECT-NEXT. Strand, V., Pope, J., Tundia, N., et al.[2021]

In a phase IIIB/IV trial involving patients with rheumatoid arthritis who did not respond adequately to methotrexate, treatment with tofacitinib in combination with methotrexate showed significantly greater improvements in patient-reported outcomes like pain and overall disease activity compared to tofacitinib monotherapy.

All treatment groups, including tofacitinib monotherapy and combinations with methotrexate or adalimumab, demonstrated clinically meaningful improvements in patient-reported outcomes, but the differences were small, suggesting that while combination therapies may offer some benefits, the overall clinical significance may be limited.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient-reported outcomes for tofacitinib with and without methotrexate, or adalimumab with methotrexate, in rheumatoid arthritis: a phase IIIB/IV trial. Strand, V., Mysler, E., Moots, RJ., et al.[2020]

References

1. England pubmed.ncbi.nlm.nih.gov

Upadacitinib improves patient-reported outcomes vs placebo or adalimumab in patients with rheumatoid arthritis: results from SELECT-COMPARE. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Improvement in Patient-Reported Outcomes in Patients with Psoriatic Arthritis Treated with Upadacitinib Versus Placebo or Adalimumab: Results from SELECT-PsA 1. [2022]

3. New Zealand pubmed.ncbi.nlm.nih.gov

Upadacitinib: First Approval. [2020]

4. England pubmed.ncbi.nlm.nih.gov

Effects of upadacitinib on patient-reported outcomes: results from SELECT-BEYOND, a phase 3 randomized trial in patients with rheumatoid arthritis and inadequate responses to biologic disease-modifying antirheumatic drugs. [2023]

5. England pubmed.ncbi.nlm.nih.gov

Upadacitinib improves patient-reported outcomes in patients with rheumatoid arthritis and inadequate response to conventional synthetic disease-modifying antirheumatic drugs: results from SELECT-NEXT. [2021]

6. New Zealand pubmed.ncbi.nlm.nih.gov

Upadacitinib in Rheumatoid Arthritis: A Benefit-Risk Assessment Across a Phase III Program. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Comparison of the efficacy and safety of tofacitinib and upadacitinib in patients with active rheumatoid arthritis: A Bayesian network meta-analysis of randomized controlled trials. [2020]

8. England pubmed.ncbi.nlm.nih.gov

Upadacitinib versus placebo or adalimumab with background methotrexate in patients with rheumatoid arthritis and an inadequate response to methotrexate: a subgroup analysis of a phase III randomized controlled trial in Central and Eastern European patients. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Exposure-Response Analyses of Upadacitinib Efficacy and Safety in Phase II and III Studies to Support Benefit-Risk Assessment in Rheumatoid Arthritis. [2020]

10. England pubmed.ncbi.nlm.nih.gov

Safety and effectiveness of upadacitinib or adalimumab plus methotrexate in patients with rheumatoid arthritis over 48 weeks with switch to alternate therapy in patients with insufficient response. [2020]

11. England pubmed.ncbi.nlm.nih.gov

Patient-reported outcomes for tofacitinib with and without methotrexate, or adalimumab with methotrexate, in rheumatoid arthritis: a phase IIIB/IV trial. [2020]

12. England pubmed.ncbi.nlm.nih.gov

Long-term safety and efficacy of upadacitinib or adalimumab in patients with rheumatoid arthritis: results through 3 years from the SELECT-COMPARE study. [2023]