SELECT - Choice UPA Vs ABA In RA - Dr. Jack Cush Save
Dr. Jack Cush from EULAR2020 Virtual Conference
OP0151
Transcription
Hi. I'm Jack Cush with RheumNow. I wanna tell you about an interesting rheumatoid arthritis study. I think this may have been the best study from EULAR twenty '20. It's a head to head trial of upa versus abba, upadacitinib versus abatacept in patients who are biologic refractory, either had non response or incomplete response to prior biologic therapies.
Six hundred and twelve patients were enrolled in this randomized active control trial. Patients were randomized to either receive fifteen milligrams of upa or monthly infusions after loading dose of abatacept. The out primary endpoint in this study was a dash 28 CRP of less than 2.6 sort of remission, and that that would be at week twenty four. Again, the interesting thing about this study was it was designed as a non inferiority trial, and in the end, it proved to be a superiority trial because upadacitinib was in fact more efficacious than was abetacept. Again, the numbers at week 24, forty six percent achieved remission with upa, thirty one percent achieved remission with aba.
Many of the parameters, LDA, ACR 20, ACR 50, ACR 70, were all significant at week twelve. By week 24, ACR 20 was no longer significant. That's an interesting finding. But ACR 50 still was, and ACR 70 still was. I mean, ACR seventy, seventy three percent versus twenty six percent.
Those are that that's a really impressive number, especially in these refractory patients because they will have already failed other DMARDs and other multiple other therapies, including at least one DMARD, one biologic DMARD. So it was not a non inferiority. It was in fact a a superior, outcome compared to its comparative drug. The interesting hook in this study is that while better in clinical efficacy, upa came with a price. There was more toxicity with upa.
So many of the usual parameters were not bad, but some of the ones that are worrisome were higher. That would include serious AEs, were a bit more frequent with this, with the JAK inhibitor, 10 versus five. Severe AEs, 19 versus 10. Opportunistic infections, four versus one. Hepatic disorders, very strange, but 23 versus five, that's seven point six percent versus one point six percent.
There was no difference in shingles events, zoster, or in venous thromboembolic events between the two two drugs. But OOPA had more lab abnormalities, mainly grade three and four lymphopenia. Four is less than five hundred, and that was fourteen point nine percent versus eight point four percent. And grade three and four CPK CPK elevations, three cases versus no cases. So which would you use?
Your patient's been through the mill, tried a bunch of things. Do you go to the newer JAK inhibitor? You go with Abba? It depends on on what you want. Realize this is not a very simple study because these people are sick.
They will have failed multiple other therapies. And in this case, they need something that works. If you will need something that works, you might be swayed by the efficacy data. However, if your patient or you are really worried about toxicity, maybe you shy away from the OOPA and you go to ABBA. But this is novel in that it is head to head.
Rheumatologists love head to head. There's not a lot of evidence that you, in fact, change your therapy when you get head to head results, but this could be a game changer. You know, OOPA has been shown in other studies head to head to be better than, and I can see the same for other JAK inhibitors too. That JAK JAK inhibitors and OOPA are better than methotrexate. And in many instances, they are better than adalimumab.
And now we have another MOA where the JAK inhibitor seemed to work. So I think this is a great study because it's moving the needle and the paradigm towards JAK inhibition in the future when these may become more more affordable, and more accessible. I I think right now, you know, we're still locked into methotrexate because of cost and convention, but, you know, the JAKs are gonna challenge that, and especially being able to beat the competition head to head, methotrexate, adalimumab, and now abetacept. Things are gonna change in the future, not this week, but in the future. Interesting study.
Hope you liked it. This is Saturday, SAT o one five one is the abstract number.
Six hundred and twelve patients were enrolled in this randomized active control trial. Patients were randomized to either receive fifteen milligrams of upa or monthly infusions after loading dose of abatacept. The out primary endpoint in this study was a dash 28 CRP of less than 2.6 sort of remission, and that that would be at week twenty four. Again, the interesting thing about this study was it was designed as a non inferiority trial, and in the end, it proved to be a superiority trial because upadacitinib was in fact more efficacious than was abetacept. Again, the numbers at week 24, forty six percent achieved remission with upa, thirty one percent achieved remission with aba.
Many of the parameters, LDA, ACR 20, ACR 50, ACR 70, were all significant at week twelve. By week 24, ACR 20 was no longer significant. That's an interesting finding. But ACR 50 still was, and ACR 70 still was. I mean, ACR seventy, seventy three percent versus twenty six percent.
Those are that that's a really impressive number, especially in these refractory patients because they will have already failed other DMARDs and other multiple other therapies, including at least one DMARD, one biologic DMARD. So it was not a non inferiority. It was in fact a a superior, outcome compared to its comparative drug. The interesting hook in this study is that while better in clinical efficacy, upa came with a price. There was more toxicity with upa.
So many of the usual parameters were not bad, but some of the ones that are worrisome were higher. That would include serious AEs, were a bit more frequent with this, with the JAK inhibitor, 10 versus five. Severe AEs, 19 versus 10. Opportunistic infections, four versus one. Hepatic disorders, very strange, but 23 versus five, that's seven point six percent versus one point six percent.
There was no difference in shingles events, zoster, or in venous thromboembolic events between the two two drugs. But OOPA had more lab abnormalities, mainly grade three and four lymphopenia. Four is less than five hundred, and that was fourteen point nine percent versus eight point four percent. And grade three and four CPK CPK elevations, three cases versus no cases. So which would you use?
Your patient's been through the mill, tried a bunch of things. Do you go to the newer JAK inhibitor? You go with Abba? It depends on on what you want. Realize this is not a very simple study because these people are sick.
They will have failed multiple other therapies. And in this case, they need something that works. If you will need something that works, you might be swayed by the efficacy data. However, if your patient or you are really worried about toxicity, maybe you shy away from the OOPA and you go to ABBA. But this is novel in that it is head to head.
Rheumatologists love head to head. There's not a lot of evidence that you, in fact, change your therapy when you get head to head results, but this could be a game changer. You know, OOPA has been shown in other studies head to head to be better than, and I can see the same for other JAK inhibitors too. That JAK JAK inhibitors and OOPA are better than methotrexate. And in many instances, they are better than adalimumab.
And now we have another MOA where the JAK inhibitor seemed to work. So I think this is a great study because it's moving the needle and the paradigm towards JAK inhibition in the future when these may become more more affordable, and more accessible. I I think right now, you know, we're still locked into methotrexate because of cost and convention, but, you know, the JAKs are gonna challenge that, and especially being able to beat the competition head to head, methotrexate, adalimumab, and now abetacept. Things are gonna change in the future, not this week, but in the future. Interesting study.
Hope you liked it. This is Saturday, SAT o one five one is the abstract number.
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