Comparing upadacitinib to abatacept for patients with rheumatoid arthritis

This study investigated the effectiveness and safety of upadacitinib (Rinvoq) to abatacept (Orencia) for patients with rheumatoid arthritis (RA).

The study showed that upadacitinib was more effective in lowering the disease activity score (DAS28) and in decreasing symptoms, but had more side effects compared to abatacept.

RA is an inflammatory condition commonly treated with disease-modifying antirheumatic drugs (DMARDs) like upadacitinib. They aim to suppress the activity of the immune system, calming down inflammation, and decreasing the disease-related symptoms. Common symptoms of RA include swelling of joints, pain, fatigue, and impacted function. These symptoms often fluctuate over the course of the disease.

If the disease is very active and causing heavy symptoms can be determined by measuring c-reactive protein (CRP) blood levels. In addition, 28 joints are assessed in regard to the intensity of symptoms. Higher levels of CRP and more affected joints indicate that the RA is more active which will result in a higher score of DAS28. This shows that the patients’ quality of life is more impacted. When the disease is reducing (in remission), DAS28 will be lower. 

Abatacept is a biologic drug that works in a different way than DMARDs. It interferes with the communication of cells causing inflammation in order to inhibit their function and reduce inflammation overall. Upadacitinib and abatacept have each been approved individually for RA. However, their compared effectiveness and side-effects are unknown. 

This study included 612 patients with RA. 303 were randomly assigned to receive upadacitinib 15mg daily as a pill and a placebo to the veins. 309 were randomly assigned to receive abatacept between 500 to 1000 mg (depending on body weight) of abatacept into the veins 7 times during the study and a placebo pill daily. The study lasted for 24 weeks. Over the course of the study, all patients continued to take their specified medication like DMARDs additionally. 

Both groups had reductions in DAS28 scores at week 12. The remission of RA was documented for 30% of the patients in the upadacitinib group compared to 13.3% in the abatacept group.  

Severe side-effects were reported by 1.6% of the abatacept group and by 3.3% of the upadacitinib group. Serious infections occurred in 1% of the upadacitinib group and 0.3% of the abatacept-group. Liver problems occurred in 1.6% in the abatacept group, compared to 7.6% in the upadacitinib group. 

The authors concluded, that upadacitinib showed better effectiveness in reducing symptoms of RA over abatacept while causing more severe side-effects. 

The study was supported by AbbVie, the pharmaceutical company producing upadacitinib.