Upadacitinib for the treatment of rheumatoid arthritis following previous therapy with biologics or JAK inhibitors

In 2020, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into whether upadacitinib has any advantages or disadvantages compared with the standard treatment in adults who did not benefit enough from – or who cannot tolerate – treatment with one or more biologics or JAK inhibitors.

The manufacturer provided one relevant study. The IQWiG researchers used the data on about 450 patients in their analysis. One half of these patients were given upadacitinib, and the other half received abatacept. Both groups received methotrexate (MTX) too.

The following results were found after half a year:

What are the advantages of upadacitinib?

  • 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 in patients aged 65 and over here: In this group, 27 out of 100 people had a remission, compared with only 6 out of 100 people who had abatacept plus MTX .
  • Disease activity: Here the study also suggests that upadacitinib plus MTX has an advantage in patients who had a high level of disease activity at the start of the study: In this group, the disease activity decreased in about 59 out of 100 people. In the group that was given abatacept plus MTX, it decreased in about 46 out of 100 people.

What are the disadvantages of upadacitinib?

Upadacitinib plus MTX didn’t have any disadvantages compared to abatacept plus MTX.

No difference

No difference was found between the groups in terms of the following aspects:

  • Life expectancy
  • Tender and swollen joints
  • Pain
  • Estimation of disease activity as reported by the patient
  • Physical functioning
  • Fatigue
  • Severity and duration of morning stiffness in the joints
  • General health
  • Physical and emotional quality of life
  • 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


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

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