Upadacitinib is Superior to Methotrexate in Early RA Save
In a head-to-head trial against methotrexate, JAK1 inhibition with upadacitinib was shown to be more effective in early, DMARD-naive rheumatoid arthritis (RA) patients.
The SELECT‐EARLY trial compared 24 week outcomes in 947 early RA patients treated with either daily upadacitinib (15mg or 30mg) or weekly methotrexate. The co-primary endpoints were:the ACR50 response at Week 12, and DAS28-CRP <2.6 (remission) at Week 24. The primary results are shown below.
| UPA 15mg | UPA 30 mg | MTX | |
| ACR50 @wk 12 | 52% | 56% | 28% |
| DAS-CRP <2.6 @ wk 24 | 48% | 50% | 19% |
The week 24 ACR20 responses also favored UPA (78%, 79%) over MTX (58%). These statistically significant clinical outcomes were mirrored by other patient‐reported outcomes (e.g., HAQ, SF-36, FACIT-F). Moreover, greater radiographic protection was seen with UPA (compared to MTX) with 88% and 89% of upadacitinib treated patients showing no radiographic progression (mTSS ≤0) versus 78% with methotrexate ( P<0.01).
No new safety signals were identified, and deaths in the trial were rare and evenly distributed (2 UPA 15mg; 3 upadacitinib 30mg; and 1 methotrexate).
These clinical trial data show the superiority of UPA over MTX and confirm little added efficacy for the UPA 30 mg, over the UPA 15 mg dose.
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