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Upadacitinib 15 mg daily achieves DAS28-CRP ≤3.2 in 43.3% of patients versus 22.4% for adalimumabTrial shows upadacitinib outperforms adalimumab for rheumatoid arthritis patients

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Key Takeaway
Consider upadacitinib 15 mg daily as a superior alternative to adalimumab for patients with rheumatoid arthritis failing TNFi.

This randomized controlled trial evaluated the efficacy of upadacitinib 15 mg once daily versus adalimumab 40 mg every-other-weekly in 492 patients with rheumatoid arthritis who had a prior inadequate response or intolerance to a tumor necrosis factor inhibitor (TNFi) while on stable methotrexate.

At week 12, upadacitinib demonstrated superiority in the primary outcome of achieving DAS28-CRP ≤3.2 (43.3% vs 22.4%; 95% CI: 12.9-29.1; P <.0001). Secondary outcomes also favored upadacitinib, including ACR50 (38.2% vs 26.8%; P =.0068), DAS28-CRP <2.6 (28.4% vs 14.5%; P =.0002), and a greater mean reduction in DAS28-CRP (-2.432 vs -1.840; P <.0001). Additionally, patients on upadacitinib reported a significantly greater reduction in pain scores (-3.165 vs -2.373; P =.0005).

Safety was reported as comparable between both treatment groups. However, no significant difference was observed in the HAQ-DI change (-0.523 vs -0.496; P =.5849). Upadacitinib demonstrated superiority over adalimumab across several primary and secondary endpoints at 12 weeks for patients switching after TNFi failure.

How this fits prior evidence

How this fits prior evidence: This finding extends the understanding of JAK inhibitor efficacy in rheumatoid arthritis. Specifically, it supports the previous finding that JAK and IL-6 inhibitors outperform TNF inhibitors for activity limitation in rheumatoid arthritis. While other findings noted upadacitinib's role in lichen sclerosus or atopic dermatitis, this study specifically addresses the superiority of upadacitinib over adalimumab in patients who have already failed TNFi therapy.

Living with rheumatoid arthritis can be incredibly draining, especially when the first line of treatment fails. For many patients, this means searching for a new way to manage pain and joint damage. A recent study looked at what happens when these patients switch from a common drug called adalimumab to a different medication called upadacitinib.

The trial involved 492 people who were already taking methotrexate but had not seen success with a previous type of treatment. After 12 weeks, the results showed that those taking upadacitinib saw better improvements in their disease activity scores and reported less pain compared to those on adalimumab. Specifically, more people on upadacitinib reached key goals for reducing inflammation.

While both drugs were found to be equally safe during the 12-week period, upadacitinib showed clear advantages in several areas of relief. However, it is important to note that while pain scores improved more with upadacitinib, some measures of daily disability did not show a significant difference between the two treatments.

What this means for you:
Upadacitinib outperformed adalimumab in reducing pain and inflammation for patients who failed prior treatments.

Common questions

Is upadacitinib safer than adalimumab?

The study found that safety was comparable between both treatments during the 12-week trial. While patients on upadacitinib saw better improvements in pain and disease activity, there were no reported differences in safety signals between the two medications.

Who is this finding most helpful for?

This study specifically looked at people with rheumatoid arthritis who were already taking methotrexate but had a poor response or could not tolerate a previous treatment called a tumor necrosis factor inhibitor (TNFi).

How much did pain levels change?

Patients on upadacitinib saw a greater reduction in pain scores compared to those on adalimumab. Specifically, the pain score changed by -3.165 for the upadacitinib group versus -2.373 for the adalimumab group over 12 weeks.

Study Details

Study typeRct
EvidenceLevel 2
Follow-up2.8 mo
PublishedJul 2026
View Original Abstract ↓
OBJECTIVES: After the first tumour necrosis factor inhibitor (TNFi) failure, patients with rheumatoid arthritis (RA) often cycle to a second; however, switching mechanisms of action has been postulated to improve outcomes. The ongoing SELECT-SWITCH trial compared upadacitinib with adalimumab for active RA after first TNFi failure at 12 weeks. METHODS: Patients with inadequate response or intolerance to 1 nonadalimumab TNFi receiving stable methotrexate were randomised (1:1) to 15 mg once daily upadacitinib or 40 mg every-other-weekly adalimumab. The primary endpoint was achieving superiority in Disease Activity Score 28 (DAS28)-C-reactive protein (CRP) ≤3.2 at week 12. Ranked secondary endpoints (week 12, superiority) were (1) achieving ≥50% improvement in American College of Rheumatology response criteria (ACR50); (2) achieving DAS28-CRP <2.6; change from baseline in (3) DAS28-CRP; (4) pain; (5) Health Assessment Questionnaire Disability Index (HAQ-DI). RESULTS: Overall, 492 patients were randomised. Baseline characteristics were balanced between groups. Week 12 DAS28-CRP ≤3.2 response was superior with upadacitinib (43.3%) vs adalimumab (22.4%; difference, 21.0% [95% CI: 12.9-29.1]; P < .0001) as were ACR50 (38.2% vs 26.8% [P = .0068]), DAS28-CRP <2.6 (28.4% vs 14.5%; P = .0002), mean changes in DAS28-CRP (-2.432 vs -1.840; P < .0001) and pain (-3.165 vs -2.373; P = .0005), but not in HAQ-DI (-0.523 vs -0.496; P = .5849). Safety was comparable between treatments. CONCLUSIONS: The primary endpoint of the SELECT-SWITCH trial was met, with a higher percentage of patients with active RA who switched to upadacitinib after first TNFi failure achieving DAS28-CRP ≤3.2 at 12 weeks than those cycling to a second TNFi, adalimumab, with generally similar safety profiles. GOV IDENTIFIER: NCT05814627.
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