Switching between upadacitinib and adalimumab offers benefits in patients with unresponsive rheumatoid arthritis.

This trial was carried out to examine the effectiveness of switching from upadacitinib (UPA; Rinvoq) to adalimumab (ADA; Humira) and from ADA to UPA following insufficient response in patients with rheumatoid arthritis (RA). The authors found that patients who do not respond to UPA or ADA can be effectively and safely switched to the other drug.

RA is a disease primarily affecting the joints, causing hot, painful, and swollen joints. RA can also have non-joint effects on the body such as skin, eye, kidney, and heart disease. The usual treatment strategy involves drugs that reduce inflammation. Changes in the dose or type of therapy can be used until remission is reached. In patients who do not respond to standard therapy, guidelines suggest using biologic or targeted disease-modifying anti-rheumatic drugs (DMARDs). 

UPA is a Janus kinase inhibitor (JAKi). This can help to reduce inflammation in the body that is present in RA. ADA is a biological DMARD (bDMARD). It blocks another inflammatory protein called tumor necrosis factor (TNF). Previous studies have not examined the effectiveness of switching from a JAKi to a bDMARD for the treatment of RA. 

Overall, 978 patients with RA were included in this trial. 651 patients who were initially treated with UPA and 327 patients were initially treated with ADA. 38.7% of patients who did not achieve remission on UPA switched to ADA. 48.6% of patients who did not achieve remission on ADA were switched to UPA. Participants were evaluated after 6 months.

In patients with no response to UPA treatment, 59.3% had a 20% improvement in RA symptoms after 6 months of ADA treatment. 25.9% of these patients had a 50% improvement and 12.3% had a 70% improvement after 6 months. In patients with a partial response to UPA, 77.3% achieved a 20% improvement, 46.7% achieved a 50% improvement, and 18.5% had a 70% improvement in RA symptoms after 6 months of ADA treatment. Low disease activity was reached by 36% of non-responders and by 45% of partial responders after switching to ADA. 

In patients with no response to ADA treatment, 74.6% had a 20% improvement and 49.3% had a 50% improvement in RA symptoms 6 months after switching to UPA. 23.6% of patients had a 70% improvement in RA symptoms after switching to UPA. In patients with a partial response to ADA, 86.7% had a 20% improvement, 62.5% had a 50% improvement and 39.2% had a 70% improvement in RA symptoms after switching to UPA. 47.1% of non-responders and 57.9% of incomplete-responders reached low disease activity after switching to UPA.

The rate of side effects was similar in both groups regardless of what therapeutic switch was being made. No new side effects were reported in this trial. 

The authors concluded that in patients with RA who do not respond to upadacitinib switching to adalimumab and the other way around offered improved outcomes. 

This study was sponsored by AbbVie, the manufacturer of both UPA and ADA.