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Striving for Clinical Remission in Rheumatoid Arthritis

  • Sponsored By AbbVie Medical Affairs
Aug 01, 2020 7:00 am

Sponsored by AbbVie Medical Affairs

Despite treatment, some patients with rheumatoid arthritis (RA) fail to achieve remission or even low disease activity (LDA). Routine assessment of disease activity is a critical aspect of managing RA, and there are multiple composite measures that can be reliably used in clinical settings. The SELECT program evaluated the efficacy of upadacitinib (UPA), with or without methotrexate (MTX), across a variety of remission measures.

Clinical Remission Can Be Associated With Improved Patient Outcomes and Is the Preferred Goal Of Treatment

Recommendations for the treatment of RA highlight clinical remission as the ideal treatment goal, as it can result in improved patient outcomes compared with other treatment targets, including LDA.1-3 Multiple studies have shown that quality of life and functional outcomes can be improved in patients who achieve remission versus those who achieve LDA.4,5 In addition, failing to achieve remission in a timely manner can result in irreversible consequences for patients with RA. Data from the ESPOIR cohort of French patients with early RA demonstrate that patients who remain in persistent, moderate disease activity within the first year following diagnosis experience significantly greater joint damage at 3-year follow-up, compared with patients who achieve clinical remission.

Despite considerable advancements in RA treatments within the last few decades,1,7 approximately one-third of patients with RA in the United States fail to achieve remission or LDA while on continuous advanced therapy.8 Furthermore, while there are multiple composite measures that can reliably discern among disease activity states (high, moderate, low, and remission) and are feasible to adopt in clinical practice, such criteria are inconsistently utilized in clinical settings.7 When adopted in routine practice, composite measures can serve as tools to effectively assess disease activity and remission.7

1. Smolen JS, et al. Ann Rheum Dis. 2016;75(1):3-15; 2. Singh JA, et al. Arthritis Rheumatol. 2016;68(1):1-26; 3. Smolen JS, et al. Ann Rheum Dis. 2017;76(6):960-977; 4. Nikiphorou E, et al. Rheumatology (Oxford). 2020;59(6):1272-1280; 5. Radner H, et al. Arthritis Res Ther. 2014;16(1):R56; 6. Combe B, et al. Ann Rheum Dis. 2015;74(4):724-729; 7. Anderson J, et al. Arthritis Care Res (Hoboken). 2012;64(5):640–647; 8. Pappas DA, et al. Poster 549. 2018 ACR Annual Meeting. October 19-24, 2018; Chicago, IL.

Click on the infographic below to view it in a separate tab.

Patients with RA Experience Moderate to High Disease Activity Despite Advanced Therapy

Upadacitinib, With or Without MTX, Was Assessed in MTX-IR Patients

Upadacitinib, or UPA, is an oral, small-molecule Janus kinase (JAK) inhibitor for adults with moderately to severely active RA who have had an inadequate response (IR) or intolerance to methotrexate (MTX). Use of UPA in combination with other JAK inhibitors, biologic disease-modifying antirheumatic drugs (bDMARDs), or with potent immunosuppressants, such as azathioprine and cyclosporine, is not recommended. UPA is approved as a 15-mg once-daily tablet that can be used in combination with MTX or other nonbiologic DMARDs or as monotherapy.1

The SELECT phase 3 clinical program consisted of 5 studies evaluating UPA across patient populations ranging from MTX-naïve to bDMARD-IR. Two of the 5 clinical trials assessed UPA in MTX-IR patients; in SELECT-COMPARE, patients were treated with placebo (PBO), adalimumab (ADA), or UPA, and all patients received background MTX, whereas in SELECT-MONOTHERAPY, patients were randomized to blindly continue their previous dose of MTX or to switch to UPA monotherapy.1-3 

1. RINVOQ™ (upadacitinib) [package insert]. North Chicago, IL: AbbVie Inc; 2020. 2. Fleischmann R, et al. Arthritis Rheumatol. 2019;71(11):1788-1800. 3. Smolen JS, et al. Lancet. 2019;393(10188):2303-2311.

Click on the infographic below to view it in a separate tab. 

Overview of SELECT-COMPARE and SELECT-MONOTHERAPY Trial Designs

UPA, With or Without MTX, Achieved Remission Across Multiple Composite Measures

Regardless of whether UPA was administered with or without MTX, a greater proportion of patients treated with UPA achieved clinical remission across multiple composite measures compared with active controls: placebo + MTX, ADA + MTX, and continuous methotrexate (cMTX).1-5

While remission is the preferred target, LDA is an acceptable alternative for patients who have long-standing disease or have difficulty attaining remission.6 A greater proportion of patients treated with UPA, with or without MTX, also achieved LDA across a variety of composite measures, compared with active controls: placebo + MTX, ADA + MTX, and cMTX.1-4,7,8

(Click the arrow below to view the proportion of patients achieving remission and LDA with UPA, with or without MTX, across multiple measures.

1. Fleischmann R, et al. Arthritis Rheumatol. 2019;71(11):1788-1800; 2. Smolen JS, et al. Lancet. 2019;393(10188):2303-2311; 3. Supplement to: Fleischmann R, et al. Arthritis Rheumatol. 2019;71(11):1788-1800; 4. Supplement to: Smolen JS, et al. Lancet. 2019;393(10188):2303-2311; 5. Data on File. AbbVie. ABVRRTI68651; 6. Smolen JS, et al. Ann Rheum Dis. 2016;75(1):3-15; 7. Data on File. AbbVie. ABVRRTI70802. 8. Data on File. AbbVie. ABVRRTI68627.

UPA, With or Without MTX, Achieved Remission Across Multiple Composite Measures Through ~1 Year

Remission achieved by UPA, either with or without MTX, was observed through approximately one year of treatment and was consistent across the various composite measures.

(Click the arrow below to view the proportion of patients achieving remission with UPA, with or without MTX, across various measures through ~1 year.)

UPA Safety Profile Across the Select Phase 3 Program

Review accompanying RINVOQ™ (upadacitinib) and HUMIRA® (adalimumab) full Prescribing Information for additional information, visit www.rxabbvie.com or contact AbbVie Medical Information at 1-800-633-9110.

Content developed by AbbVie Inc. This content is intended for US/PR Health Care Professionals. The US Medical Affairs department of AbbVie Inc. is the copyright owner of this presentation and has paid RheumNow to host this content.

AbbVie is solely responsible for all written and oral content within this presentation © 2020 AbbVie Inc. All rights reserved.

AbbVie Inc. JAKa-US-00011-MC Approval Date: 07/2020 v1.0

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