Based on results from the Phase 3b/4 SELECT-SWITCH trial, AbbVie’s Rinvoq (upadacitinib) demonstrated superior efficacy over Humira (adalimumab) in treating rheumatoid arthritis (RA) patients who had an inadequate response to or intolerance for a prior TNF inhibitor.

SELECT-SWITCH is the first head-to-head Phase 3b/4 trial comparing TNF inhibitor cycling with switching to a JAK inhibitor in patients with moderate to severe RA on a stable background of methotrexate (MTX).

The SELECT-SWITCH study, first head-to-head Phase 3b/4 trial, compared switching to Rinvoq versus switching to another TNF inhibitor, in this case, Humira. The study involved 492 adults with moderate to severe RA who were already taking methotrexate.

“SELECT-SWITCH is the first study to directly compare TNF inhibitor cycling with switching to the JAK inhibitor upadacitinib,” said Dr. Eduardo Mysler, Rheumatologist and Executive Medical Director at Organización Médica de Investigación, Argentina.

“Upadacitinib demonstrated superiority in achieving both low disease activity and remission at Week 12, nearly doubling the response rates observed with adalimumab. These findings provide clinicians with strong evidence to guide treatment decisions after failure or intolerance to an initial TNF inhibitor.”

“The goal of rheumatoid arthritis treatment is to achieve remission or low disease activity,” said Andrew Anisfeld, Ph.D., Vice President, Global Medical Affairs, Immunology, AbbVie. “These results reinforce the clinical value of switching to a therapy with a different mechanism of action after an inadequate response to a first TNF inhibitor. RINVOQ continues to demonstrate its potential to help more patients reach these important treatment milestones.”

The safety profile of upadacitinib was consistent with previously reported studies. No new safety signals were identified during the 12-week treatment period. The most common treatment-emergent adverse events (≥3 per cent) were urinary tract infection, nasopharyngitis, and worsening rheumatoid arthritis.

Rates of serious adverse events were balanced across treatment groups, occurring in 2.0 per cent of patients treated with upadacitinib and 2.4 per cent of patients treated with adalimumab. One malignancy was reported in each group, and no cases of adjudicated venous thromboembolism, major adverse cardiovascular events, or deaths were observed.

The results from SELECT-SWITCH add to the growing body of evidence supporting the benefit of switching to a therapy with a different mechanism of action for patients who do not achieve adequate disease control with TNF inhibitors.