Rinvoq combo rises as optimal option in rheumatoid arthritis

Rinvoq+MTX combo improved remission achievement rate to a maximum of 3 years compared to Humira+MTX combo

Remission rate fell to around 10% when adopting stricter indexes… ‘Should select options in consideration of the higher treatment goals set”

AbbVie’s JAK inhibitor ‘Rinvoq (upadacitinib)’ in combination with MTX was found to improve the clinical remission achievement rate over the TNF-α inhibitor ‘Humira (adalimumab)’ combination therapy in rheumatoid arthritis.

 

The Rinvoq combination therapy achieved a 20% range remission rate in the most commonly used DAS28 index as well as the strictest Boolean index.

 

In the SELECT-COMPARE trial that was conducted on patients who had an inadequate response to MTX, 29% of the patients treated with Rinvoq+MTX achieved clinical remission per DAS28 at Week 12, which is a higher rate than the 18% in those treated with the adalimumab combination.

 

Such results were consistent under other evaluation indexes such as the SDAI, CDAI, Boolean index.

 

The differences were also consistent in the evaluations made at Week 26 and Week 48.

 

At Week 48, Rinvoq’s remission achievement rate was 38% per DAS28, 25% per CDAI, and 21% per Boolean.

 

Achievement of clinical remission in SELECT-COMPARE trial by disease activity evaluation index

◆Rinvoq maintained a 20% range remission rate with the Boolean index, a more stringent index than DAS28 DAS28 is the most widely used index to measure the achievement of clinical remission in rheumatoid arthritis, but Boolean is considered the most stringent index.

 

First, DAS28 is evaluated using three thresholds in 28 joints - tender joint count (TJC), swollen joint count (SJC), and patient pain score on a visual analog scale (VAS).

 

DAS28-CRP, which adds the C reactive protein (CRP) that is related to the progression of rheumatoid arthritis to DAS28, is most widely used.

 

With the Boolean index, the ▲number of tender joints (TJC)≤1 ▲number of swollen joints (SJC)≤1 ▲CRP≤1mg/dL ▲Patient Comprehensive Assessment (PGA)≤1 (on a scale of 0-10) needs to all be satisfied to be considered to be in remission, therefore the range considered and accepted as remission is narrower with the Boolean index.

 

This is why a study that analyzed the remission achievement rate of 3,209 rheumatoid arthritis patients in Korea with five disease activity indexes showed that the Boolean index had the lowest patient remission rate.

 

◆Remission achievement rate low for existing treatments when measured by various indexes…”We should consider new treatment options to meet new treatment goals” Based on data from the Korean College of Rheumatology Biologics Registry (KOBIO), the KCR Clinical Research Committee had previously presented the reemission achievement rate of rheumatoid arthritis patients who have been treated with biologics and oral targeted therapies during the past 5 years.

 

Treatments included in the analysis were TNF-α inhibitors such as Humira, etc.; ‘Actemra (tocilizumab),’ ‘Orencia (abatacept),’ and ‘Xeljanx (tofacitinib).’ The KCR analyzed the remission achievement rate of the treatments above with five disease activity assessment indexes - DAS28-CRP, DAS28-ESR, CDAI, SDAI, Boolean - and the result showed that the achievement rate differed greatly by index.

 

At week 48 after starting treatment, the remission achievement rate was near 56.0% per DAS28-CRP, but the dropped greatly to 10.4%, 12.7%, and 12.9% per more stringent indexes such as CDAI, SDAI, and Boolean, respectively.

 

The rate of patients that maintained remission for 2 or more years, or ‘continuous remission,' was 62% per DAS28-CRP, but 8%, 11%, 13% per CDAI, SDAI, Boolean, respectively.

 

With the remission rate of existing treatments falling to a 10% range in indexes that are relatively stringent compared to DAS28, the analysis was that a more detailed consideration is needed in setting a treatment strategy.

 

Young-Il Seo, professor of Rheumatology at Hallym University Sacred Heart Hospital Pyeongchon, said, “the low remission achievement rate observed with CDAI, SDAI, and Boolean index suggests that patients experience greater difficulties in reality and that improvements are needed to increase treatment satisfaction.

 

In this sense, we would need to more actively consider using treatment options that meet various indexes.”