Upadacitinib for the treatment of rheumatoid arthritis following previous basic therapy

In 2020, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of upadacitinib compared with the standard treatments in people having treatment with a biologic or a JAK inhibitor for the first time.

The manufacturer provided one relevant study. The IQWiG researchers used the data on about 1,000 patients in their analysis. 651 of these patients were given upadacitinib in combination with methotrexate (MTX), and 327 participants received a combination of adalimumab and MTX.

The following results were found after half a year:

What are the advantages of upadacitinib?

  • Life expectancy: During the study, 2 out of 327 people who had treatment with adalimumab in combination with MTX passed away, compared to none of the people in the group that was given upadacitinib and MTX.
  • Rheumatoid arthritis remission: Remission means that the symptoms almost go away completely – for good, or at least temporarily. The study suggests that the combination of upadacitinib and MTX has an advantage here: 23 out of 100 people in that group had a remission, compared to only 14 out of 100 people who had adalimumab in combination with MTX.
  • Disease activity: The study also suggested that the combination of upadacitinib and MTX has an advantage in this respect: Rheumatoid arthritis activity decreased in about 53 out of 100 people in this group. In the group that was given adalimumab and MTX, the activity decreased in about 38 out of 100 people.
  • Physical functioning: Based on the early results, the study suggests that people who had treatment with upadacitinib and MTX were better able to cope with physical activities of daily living such as shopping, eating or personal hygiene than people who were given adalimumab and MTX.
  • Health-related quality of life: Based on the early results, the study suggests that the combination of upadacitinib and MTX has an advantage in terms of physical quality of life. There were no differences between the treatments regarding emotional quality of life.

What are the disadvantages of upadacitinib?

There is no data suggesting that upadacitinib and MTX has any disadvantages compared to adalimumab and MTX.

No difference

There was no difference between the two treatment groups in terms of the following aspects:

  • Tender or swollen joints
  • Pain
  • Estimation of disease activity as reported by the patient
  • Fatigue
  • Severity and duration of morning stiffness in the joints
  • General health
  • Severe side effects
  • Treatment stopped due to side effects
  • Infections and severe infections

What remains unanswered?

There is no data on patients who are given upadacitinib only (monotherapy).

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Upadacitinib (rheumatoid arthritis) – Benefit assessment according to §35a Social Code Book V. Dossier assessment; Commission A20-08. April 29, 2020. (IQWiG reports; Volume 908).

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on May 20, 2020
Next planned update: 2023

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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