POS0653 IMPACT OF UPADACITINIB OR ADALIMUMAB AS INITIAL THERAPY ON THE ACHIEVEMENT OF 48-WEEK TREATMENT GOALS IN PATIENTS WITH RHEUMATOID ARTHRITIS AND INADEQUATE RESPONSE TO METHOTREXATE: POST HOC ANALYSIS OF A PHASE 3 STUDY

Abstract

Background:In the randomized, double-blinded, Phase 3 SELECT-COMPARE study, upadacitinib (UPA) + MTX demonstrated greater clinical and functional responses vs adalimumab (ADA) + MTX in patients (pts) with RA and inadequate response to MTX.1,2 Pts with insufficient response to initial therapy were switched from UPA to ADA (and vice versa) according to treat-to-target (T2T) principles.Objectives:We analyzed 1-year treatment outcomes in SELECT-COMPARE according to initial randomization group, regardless of whether pts subsequently switched therapy.Methods:Pts initially randomized to UPA 15 mg once daily (QD) or ADA 40 mg every other week (EOW; both + MTX) for up to 48 weeks in SELECT-COMPARE were included in the analysis. As per the protocol-directed rescue strategy, pts experiencing <20% improvement in tender or swollen joint counts at Week 14, 18, or 22, or Clinical Disease Activity Index (CDAI) >10 at Week 26, were switched from UPA to ADA or ADA to UPA in a blinded fashion. Efficacy outcomes included CDAI remission (≤2.8) and low disease activity (LDA; ≤10), DAS of 28 joints using CRP (DAS28[CRP]) <2.6 and ≤3.2, and a composite of “deep response” (CDAI remission, HAQ-Disability Index <0.5, and pain score <20). Data are presented and attributed to initial randomized group (UPA or ADA) regardless of any subsequent switch in therapy. Time-averaged response rates were calculated as area under the curve of response rate standardized by 48 weeks. The proportions of pts who maintained Week 26 responses through 6 months of follow-up are also reported.Results:This analysis included 651 pts initially randomized to UPA (of whom 245 switched to ADA) and 327 pts initially randomized to ADA (of whom 157 switched to UPA). Baseline characteristics including age, sex, and BMI were generally well balanced between randomized groups. At Week 48, similar proportions of pts initially randomized to UPA or ADA therapy achieved CDAI remission/LDA (27.6%/61.9% vs 24.8%/59.0%) and DAS28(CRP) <2.6/≤3.2 (45.0%/60.2% vs 43.7%/59.0%) (Figure 1). However, a small but significantly greater proportion of pts achieved a deep response with initial UPA vs initial ADA therapy (17.8% vs 12.8%; p<0.05). In addition, time-averaged response rates over 48 weeks were higher for initial UPA vs initial ADA therapy across efficacy outcomes. Similar trends were observed for other outcomes. Additionally, similar proportions of pts maintained Week 26 responses with initial UPA vs initial ADA therapy based on CDAI remission/LDA and DAS28(CRP) <2.6/≤3.2 during 6-month follow-up (Table 1).Conclusion:Using a stringent T2T approach to RA management, rates of LDA or remission at 1 year were similar, regardless of whether pts were initially randomized to UPA or ADA. However, initial UPA therapy led to more frequent deep responses and higher time-averaged response rates vs initial ADA therapy.