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A Study Comparing Upadacitinib (ABT-494) Monotherapy to Methotrexate (MTX) Monotherapy in Adults With Rheumatoid Arthritis (RA) Who Have an Inadequate Response to MTX (SELECT-MONOTHERAPY)

A Phase 3, Randomized, Double-Blind Study Comparing Upadacitinib (ABT-494) Monotherapy to Methotrexate (MTX) in Adults With Moderately to Severely Active Rheumatoid Arthritis With Inadequate Response to MTX

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02706951
Enrollment
648
Registered
2016-03-11
Start date
2016-03-23
Completion date
2022-08-10
Last updated
2024-01-30

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Rheumatoid Arthritis

Keywords

Musculoskeletal Disease, Arthritis, Joint Disease, Anti-inflammatory agents, Antirheumatic agents, Upadacitinib, ABT-494

Brief summary

The study objective of Period 1 of this study is to compare the safety and efficacy (signs and symptoms) of upadacitinib 30 mg once daily (QD) alone and upadacitinib 15 mg QD alone versus continuing MTX alone adults with moderately to severely active rheumatoid arthritis (RA) with an inadequate response to MTX. The study objective of Period 2 is to evaluate the long term safety, tolerability, and efficacy of upadacitinib 30 mg QD and 15 mg QD in adults with RA who had completed Period 1.

Detailed description

The study includes a 35-day screening period; a 14-week randomized, double-blind, parallel-group, controlled treatment period (Period 1); a 246-week blinded extension period (Period 2); and a 30-day follow-up visit. Participants who met eligibility criteria were to be randomized in a 2:2:1:1 ratio to one of four treatment groups: * Group 1: upadacitinib 30 mg QD (Period 1) → upadacitinib 30 mg QD (Period 2) * Group 2: upadacitinib 15 mg QD (Period 1) → upadacitinib 15 mg QD (Period 2) * Group 3: MTX (Period 1) → upadacitinib 30 mg QD (Period 2) * Group 4: MTX (Period 1) → upadacitinib 15 mg QD (Period 2) Starting with implementation of Protocol Amendment 5, all participants in the extension period will receive open-label upadacitinib 15 mg QD, including those currently on upadacitinib 30 mg QD.

Interventions

DRUGMethotrexate

Capsule; Oral

DRUGUpadacitinib

Tablet; Oral

DRUGPlacebo Upadacitinib

Tablet; Oral

Capsule; Oral

Sponsors

AbbVie
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
No

Inclusion criteria

* Diagnosis of RA for \>= 3 months. * Subjects must have been on oral or parenteral MTX therapy \>= 3 months and on a stable dose for \>= 4 weeks prior to first dose of study drug. * Must have discontinued all conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) (other than MTX) \>= 4 weeks prior to first dose of study drug. * Meets the following minimum disease activity criteria: \>= 6 swollen joints (based on 66 joint counts) and \>= 6 tender joints (based on 68 joint counts) at Screening and Baseline Visits.

Exclusion criteria

* Prior exposure to any Janus kinase (JAK) inhibitor (including but not limited to tofacitinib, baricitinib, and filgotinib). * Prior exposure to any biological disease-modifying anti-rheumatic drugs (bDMARDs). * Current diagnosis of inflammatory joint disease other than RA. Current diagnosis of secondary Sjogren's Syndrome is permitted.

Design outcomes

Primary

MeasureTime frameDescription
Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 14Baseline and week 14The primary endpoint for United States (US)/Food and Drug Administration (FDA) regulatory purposes was ACR 20% response (ACR20) at Week 14. Participants who met the following 3 conditions for improvement from baseline were classified as meeting the ACR20 response criteria: 1. ≥ 20% improvement in 68-tender joint count; 2. ≥ 20% improvement in 66-swollen joint count; and 3. ≥ 20% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
Percentage of Participants Achieving Low Disease Activity (LDA) Based on DAS28(CRP) at Week 14Week 14The primary endpoint for European Union (EU)/European Medicines Agency (EMA) regulatory purposes was low disease activity, based on a Disease Activity Score 28 (DAS28)-CRP score of ≤ 3.2 at Week 14. The DAS28 is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (0-100 mm), and hsCRP (in mg/L). Scores on the DAS28 range from 0 to approximately 10, where higher scores indicate more disease activity. A DAS28 score less than or equal to 3.2 indicates low disease activity.

Secondary

MeasureTime frameDescription
Change From Baseline in Short-Form 36 (SF-36) Physical Component Score (PCS) at Week 14Baseline to week 14The Short Form 36-Item Health Survey (SF-36) Version 2 is a self-administered questionnaire that measures the impact of disease on overall quality of life during the past 4 weeks. The SF-36 consists of 36 questions in eight domains (physical function, pain, general and mental health, vitality, social function, physical and emotional health). The physical component score is a weighted combination of the 8 subscales with positive weighting for physical functioning, role-physical, bodily pain, and general health. The PCS was calculated using norm-based scoring so that 50 is the average score and the standard deviation equals 10. Higher scores are associated with better functioning/quality of life; a positive change from baseline score indicates an improvement.
Percentage of Participants Achieving Clinical Remission (CR) Based on DAS28(CRP) at Week 14Week 14The DAS28 is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (0-100 mm), and hsCRP (in mg/L). Scores on the DAS28 range from 0 to approximately 10, where higher scores indicate more disease activity. A DAS28 score less than 2.6 indicates clinical remission.
Change From Baseline in in Disease Activity Score 28 (CRP) at Week 14Baseline to week 14The DAS28 is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (0-100 mm), and hsCRP (in mg/L). Scores on the DAS28 range from 0 to approximately 10, where higher scores indicate more disease activity. A negative change from baseline in DAS28 (CRP) indicates improvement in disease activity.
Percentage of Participants With an American College of Rheumatology 50% (ACR50) Response at Week 14Baseline and week 14Participants who met the following 3 conditions for improvement from baseline were classified as meeting the ACR50 response criteria: 1. ≥ 50% improvement in 68-tender joint count; 2. ≥ 50% improvement in 66-swollen joint count; and 3. ≥ 50% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
Percentage of Participants With an American College of Rheumatology 70% (ACR70) Response at Week 14Baseline and week 14Participants who met the following 3 conditions for improvement from baseline were classified as meeting the ACR50 response criteria: 1. ≥ 70% improvement in 68-tender joint count; 2. ≥ 70% improvement in 66-swollen joint count; and 3. ≥ 70% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
Change From Baseline in Duration of Morning Stiffness at Week 14Baseline to week 14Participants were asked to indicate the time it took for them to get as limber as possible after awakening with morning stiffness over the past 7 days. A negative change from Baseline indicates improvement.
Change From Baseline in Heath Assessment Questionnaire and Disability Index (HAQ-DI) at Week 14Baseline to week 14The Health Assessment Questionnaire - Disability Index is a patient-reported questionnaire that measures the degree of difficulty a person has in accomplishing tasks in 8 functional areas (dressing, arising, eating, walking, hygiene, reaching, gripping, and errands and chores) over the past week. Participants assessed their ability to do each task on a scale from 0 (without any difficulty) to 3 (unable to do). Scores were averaged to provide an overall score ranging from 0 to 3, where 0 represents no disability and 3 represents very severe, high-dependency disability. A negative change from Baseline in the overall score indicates improvement.

Countries

Argentina, Australia, Austria, Belgium, Bulgaria, Chile, Czechia, Estonia, Greece, Hungary, Israel, Italy, Japan, Mexico, Poland, Portugal, Puerto Rico, Romania, Russia, Serbia, South Africa, Spain, Turkey (Türkiye), Ukraine, United States

Participant flow

Recruitment details

A total of 648 participants with rheumatoid arthritis (RA) on a stable dose of methotrexate (MTX) were randomized at 138 study sites located in 24 countries.

Pre-assignment details

Participants were randomized in a 2:2:1:1 ratio to 1 of 4 groups: * Upadacitinib 30 mg (Periods 1 and 2) * Upadacitinib 15 mg (Periods 1 and 2) * MTX (Period 1) → upadacitinib 30 mg (Period 2) * MTX (Period 1) → upadacitinib 15 mg (Period 2) Randomization was stratified by geographic region. The MTX groups were pooled for Week 14 analyses. Starting with Amend. 5 & during Period 2, all participants received open-label upadacitinib 15 mg, including participants receiving upadacitinib 30 mg

Participants by arm

ArmCount
Methotrexate
Participants randomized to receive up to 25 mg methotrexate once a week and placebo to upadacitinib once daily for 14 weeks in Period 1.
216
Upadacitinib 15 mg
Participants randomized to receive upadacitinib 15 mg once daily and placebo to methotrexate once a week for 14 weeks in Period 1.
217
Upadacitinib 30 mg
Participants randomized to receive upadacitinib 30 mg once daily and placebo to methotrexate once a week for 14 weeks in Period 1.
215
Total648

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003FG004
Period 1Adverse Event15300
Period 1Lost to Follow-up04100
Period 1Other21000
Period 1Withdrawal by Subject106600
Period 2Adverse Event0002534
Period 2COVID-19 Related00012
Period 2Lost to Follow-up000179
Period 2Other0003731
Period 2Withdrawal by Subject0003844

Baseline characteristics

CharacteristicUpadacitinib 15 mgUpadacitinib 30 mgMethotrexateTotal
Age, Continuous54.5 years
STANDARD_DEVIATION 12.2
53.1 years
STANDARD_DEVIATION 12.72
55.3 years
STANDARD_DEVIATION 11.12
54.3 years
STANDARD_DEVIATION 12.05
Age, Customized
40 - 64 years
147 Participants141 Participants148 Participants436 Participants
Age, Customized
< 40 years
28 Participants31 Participants23 Participants82 Participants
Age, Customized
≥ 65 years
42 Participants43 Participants45 Participants130 Participants
Disease Activity Score 28 Based on CRP (DAS28[CRP])5.6 units on a scale
STANDARD_DEVIATION 0.92
5.6 units on a scale
STANDARD_DEVIATION 1.06
5.6 units on a scale
STANDARD_DEVIATION 1.04
5.6 units on a scale
STANDARD_DEVIATION 1.01
Duration of RA Diagnosis7.5 years
STANDARD_DEVIATION 8.88
6.5 years
STANDARD_DEVIATION 6.98
5.8 years
STANDARD_DEVIATION 6.63
6.6 years
STANDARD_DEVIATION 7.58
Ethnicity (NIH/OMB)
Hispanic or Latino
52 Participants54 Participants50 Participants156 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
165 Participants161 Participants166 Participants492 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants
Geographic Region
Asia - Japan
22 Participants21 Participants22 Participants65 Participants
Geographic Region
Eastern Europe
80 Participants80 Participants79 Participants239 Participants
Geographic Region
North America
64 Participants64 Participants64 Participants192 Participants
Geographic Region
Other
13 Participants12 Participants12 Participants37 Participants
Geographic Region
South/Central America
30 Participants30 Participants31 Participants91 Participants
Geographic Region
Western Europe
8 Participants8 Participants8 Participants24 Participants
Health Assessment Questionnaire - Disability Index (HAQ-DI)1.5 units on a scale
STANDARD_DEVIATION 0.66
1.5 units on a scale
STANDARD_DEVIATION 0.65
1.5 units on a scale
STANDARD_DEVIATION 0.66
1.5 units on a scale
STANDARD_DEVIATION 0.66
High-sensitivity C-reactive Protein (hsCRP)14.0 mg/L
STANDARD_DEVIATION 16.49
16.3 mg/L
STANDARD_DEVIATION 20.77
14.5 mg/L
STANDARD_DEVIATION 17.33
14.9 mg/L
STANDARD_DEVIATION 18.28
Patient's Assessment of Pain62.3 mm
STANDARD_DEVIATION 22.53
61.9 mm
STANDARD_DEVIATION 22.12
62.5 mm
STANDARD_DEVIATION 21.26
62.3 mm
STANDARD_DEVIATION 21.94
Patient's Global Assessment of Disease Activity62.2 mm
STANDARD_DEVIATION 22.29
59.4 mm
STANDARD_DEVIATION 22.79
59.6 mm
STANDARD_DEVIATION 21.78
60.4 mm
STANDARD_DEVIATION 22.29
Physician's Global Assessment of Disease Activity65.7 mm
STANDARD_DEVIATION 18.49
62.6 mm
STANDARD_DEVIATION 17.81
62.1 mm
STANDARD_DEVIATION 17.47
63.5 mm
STANDARD_DEVIATION 17.98
Race/Ethnicity, Customized
American Indian/Alaska Native
4 Participants3 Participants3 Participants10 Participants
Race/Ethnicity, Customized
Asian
24 Participants21 Participants24 Participants69 Participants
Race/Ethnicity, Customized
Black or African American
15 Participants9 Participants11 Participants35 Participants
Race/Ethnicity, Customized
Multiple
1 Participants2 Participants2 Participants5 Participants
Race/Ethnicity, Customized
White
173 Participants180 Participants176 Participants529 Participants
Sex: Female, Male
Female
174 Participants170 Participants179 Participants523 Participants
Sex: Female, Male
Male
43 Participants45 Participants37 Participants125 Participants
Swollen Joint Count16.4 joints
STANDARD_DEVIATION 10.94
16.9 joints
STANDARD_DEVIATION 10.23
16.9 joints
STANDARD_DEVIATION 11.52
16.7 joints
STANDARD_DEVIATION 10.9
Tender Joint Count24.5 joints
STANDARD_DEVIATION 15.1
24.8 joints
STANDARD_DEVIATION 15.19
25.2 joints
STANDARD_DEVIATION 15.99
24.8 joints
STANDARD_DEVIATION 15.41

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
EG004
affected / at risk
EG005
affected / at risk
deaths
Total, all-cause mortality
0 / 2160 / 2170 / 2157 / 3185 / 3114 / 205
other
Total, other adverse events
49 / 21643 / 21751 / 215219 / 318211 / 31182 / 205
serious
Total, serious adverse events
7 / 21611 / 2176 / 21595 / 31875 / 31122 / 205

Outcome results

Primary

Percentage of Participants Achieving Low Disease Activity (LDA) Based on DAS28(CRP) at Week 14

The primary endpoint for European Union (EU)/European Medicines Agency (EMA) regulatory purposes was low disease activity, based on a Disease Activity Score 28 (DAS28)-CRP score of ≤ 3.2 at Week 14. The DAS28 is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (0-100 mm), and hsCRP (in mg/L). Scores on the DAS28 range from 0 to approximately 10, where higher scores indicate more disease activity. A DAS28 score less than or equal to 3.2 indicates low disease activity.

Time frame: Week 14

Population: Full analysis set; participants who prematurely discontinued from study drug prior to Week 14 or for whom DAS28 data were missing at Week 14 were considered non-responders.

ArmMeasureValue (NUMBER)
MethotrexatePercentage of Participants Achieving Low Disease Activity (LDA) Based on DAS28(CRP) at Week 1419.4 percentage of participants
Upadacitinib 15 mgPercentage of Participants Achieving Low Disease Activity (LDA) Based on DAS28(CRP) at Week 1444.7 percentage of participants
Upadacitinib 30 mgPercentage of Participants Achieving Low Disease Activity (LDA) Based on DAS28(CRP) at Week 1453.0 percentage of participants
p-value: <0.00195% CI: [16.8, 33.7]Cochran-Mantel-Haenszel
p-value: <0.00195% CI: [25.1, 42.1]Cochran-Mantel-Haenszel
Primary

Percentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 14

The primary endpoint for United States (US)/Food and Drug Administration (FDA) regulatory purposes was ACR 20% response (ACR20) at Week 14. Participants who met the following 3 conditions for improvement from baseline were classified as meeting the ACR20 response criteria: 1. ≥ 20% improvement in 68-tender joint count; 2. ≥ 20% improvement in 66-swollen joint count; and 3. ≥ 20% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).

Time frame: Baseline and week 14

Population: Full analysis set; participants who prematurely discontinued from study drug prior to Week 14 or for whom ACR data were missing at Week 14 were considered non-responders.

ArmMeasureValue (NUMBER)
MethotrexatePercentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 1441.2 percentage of participants
Upadacitinib 15 mgPercentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 1467.7 percentage of participants
Upadacitinib 30 mgPercentage of Participants With an American College of Rheumatology 20% (ACR20) Response at Week 1471.2 percentage of participants
p-value: <0.00195% CI: [17.5, 35.6]Cochran-Mantel-Haenszel
p-value: <0.00195% CI: [21, 38.9]Cochran-Mantel-Haenszel
Secondary

Change From Baseline in Duration of Morning Stiffness at Week 14

Participants were asked to indicate the time it took for them to get as limber as possible after awakening with morning stiffness over the past 7 days. A negative change from Baseline indicates improvement.

Time frame: Baseline to week 14

Population: Full analysis set participants with available data; a mixed effect model repeat measurement (MMRM) analysis with data from observed cases to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
MethotrexateChange From Baseline in Duration of Morning Stiffness at Week 14-53.03 minutes
Upadacitinib 15 mgChange From Baseline in Duration of Morning Stiffness at Week 14-94.56 minutes
Upadacitinib 30 mgChange From Baseline in Duration of Morning Stiffness at Week 14-102.34 minutes
p-value: 0.00195% CI: [-66.56, -16.5]Mixed Effect Model Repeat Measurement
p-value: <0.00195% CI: [-74.23, -24.4]Mixed Effect Model Repeat Measurement
Secondary

Change From Baseline in Heath Assessment Questionnaire and Disability Index (HAQ-DI) at Week 14

The Health Assessment Questionnaire - Disability Index is a patient-reported questionnaire that measures the degree of difficulty a person has in accomplishing tasks in 8 functional areas (dressing, arising, eating, walking, hygiene, reaching, gripping, and errands and chores) over the past week. Participants assessed their ability to do each task on a scale from 0 (without any difficulty) to 3 (unable to do). Scores were averaged to provide an overall score ranging from 0 to 3, where 0 represents no disability and 3 represents very severe, high-dependency disability. A negative change from Baseline in the overall score indicates improvement.

Time frame: Baseline to week 14

Population: Full analysis set participants with available data at baseline; multiple imputation was used for missing data.

ArmMeasureValue (LEAST_SQUARES_MEAN)
MethotrexateChange From Baseline in Heath Assessment Questionnaire and Disability Index (HAQ-DI) at Week 14-0.32 scores on a scale
Upadacitinib 15 mgChange From Baseline in Heath Assessment Questionnaire and Disability Index (HAQ-DI) at Week 14-0.65 scores on a scale
Upadacitinib 30 mgChange From Baseline in Heath Assessment Questionnaire and Disability Index (HAQ-DI) at Week 14-0.73 scores on a scale
p-value: <0.00195% CI: [-0.43, -0.22]ANCOVA
p-value: <0.00195% CI: [-0.51, -0.3]ANCOVA
Secondary

Change From Baseline in in Disease Activity Score 28 (CRP) at Week 14

The DAS28 is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (0-100 mm), and hsCRP (in mg/L). Scores on the DAS28 range from 0 to approximately 10, where higher scores indicate more disease activity. A negative change from baseline in DAS28 (CRP) indicates improvement in disease activity.

Time frame: Baseline to week 14

Population: Full analysis set participants with available data at baseline; multiple imputation was used for missing post-baseline data.

ArmMeasureValue (LEAST_SQUARES_MEAN)
MethotrexateChange From Baseline in in Disease Activity Score 28 (CRP) at Week 14-1.20 scores on a scale
Upadacitinib 15 mgChange From Baseline in in Disease Activity Score 28 (CRP) at Week 14-2.29 scores on a scale
Upadacitinib 30 mgChange From Baseline in in Disease Activity Score 28 (CRP) at Week 14-2.61 scores on a scale
p-value: <0.00195% CI: [-1.32, -0.85]ANCOVA
p-value: <0.00195% CI: [-1.64, -1.17]ANCOVA
Secondary

Change From Baseline in Short-Form 36 (SF-36) Physical Component Score (PCS) at Week 14

The Short Form 36-Item Health Survey (SF-36) Version 2 is a self-administered questionnaire that measures the impact of disease on overall quality of life during the past 4 weeks. The SF-36 consists of 36 questions in eight domains (physical function, pain, general and mental health, vitality, social function, physical and emotional health). The physical component score is a weighted combination of the 8 subscales with positive weighting for physical functioning, role-physical, bodily pain, and general health. The PCS was calculated using norm-based scoring so that 50 is the average score and the standard deviation equals 10. Higher scores are associated with better functioning/quality of life; a positive change from baseline score indicates an improvement.

Time frame: Baseline to week 14

Population: Full analysis set participants with available data; a mixed effect model repeat measurement (MMRM) analysis with data from observed cases to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
MethotrexateChange From Baseline in Short-Form 36 (SF-36) Physical Component Score (PCS) at Week 144.32 scores on a scale
Upadacitinib 15 mgChange From Baseline in Short-Form 36 (SF-36) Physical Component Score (PCS) at Week 148.28 scores on a scale
Upadacitinib 30 mgChange From Baseline in Short-Form 36 (SF-36) Physical Component Score (PCS) at Week 1410.19 scores on a scale
p-value: <0.00195% CI: [2.52, 5.42]Mixed Effect Model Repeat Measurement
p-value: <0.00195% CI: [4.42, 7.32]Mixed Effect Model Repeat Measurement
Secondary

Percentage of Participants Achieving Clinical Remission (CR) Based on DAS28(CRP) at Week 14

The DAS28 is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (0-100 mm), and hsCRP (in mg/L). Scores on the DAS28 range from 0 to approximately 10, where higher scores indicate more disease activity. A DAS28 score less than 2.6 indicates clinical remission.

Time frame: Week 14

Population: Full analysis set; participants who prematurely discontinued from study drug prior to Week 14 or for whom DAS28 data were missing at Week 14 were considered non-responders

ArmMeasureValue (NUMBER)
MethotrexatePercentage of Participants Achieving Clinical Remission (CR) Based on DAS28(CRP) at Week 148.3 percentage of participants
Upadacitinib 15 mgPercentage of Participants Achieving Clinical Remission (CR) Based on DAS28(CRP) at Week 1428.1 percentage of participants
Upadacitinib 30 mgPercentage of Participants Achieving Clinical Remission (CR) Based on DAS28(CRP) at Week 1440.5 percentage of participants
p-value: <0.00195% CI: [12.8, 26.8]Cochran-Mantel-Haenszel
p-value: <0.00195% CI: [24.6, 39.7]Cochran-Mantel-Haenszel
Secondary

Percentage of Participants With an American College of Rheumatology 50% (ACR50) Response at Week 14

Participants who met the following 3 conditions for improvement from baseline were classified as meeting the ACR50 response criteria: 1. ≥ 50% improvement in 68-tender joint count; 2. ≥ 50% improvement in 66-swollen joint count; and 3. ≥ 50% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).

Time frame: Baseline and week 14

Population: Full analysis set; participants who prematurely discontinued from study drug prior to Week 14 or for whom ACR data were missing at Week 14 were considered non-responders.

ArmMeasureValue (NUMBER)
MethotrexatePercentage of Participants With an American College of Rheumatology 50% (ACR50) Response at Week 1415.3 percentage of participants
Upadacitinib 15 mgPercentage of Participants With an American College of Rheumatology 50% (ACR50) Response at Week 1441.9 percentage of participants
Upadacitinib 30 mgPercentage of Participants With an American College of Rheumatology 50% (ACR50) Response at Week 1452.1 percentage of participants
p-value: <0.00195% CI: [18.5, 34.8]Cochran-Mantel-Haenszel
p-value: <0.00195% CI: [28.6, 45]Cochran-Mantel-Haenszel
Secondary

Percentage of Participants With an American College of Rheumatology 70% (ACR70) Response at Week 14

Participants who met the following 3 conditions for improvement from baseline were classified as meeting the ACR50 response criteria: 1. ≥ 70% improvement in 68-tender joint count; 2. ≥ 70% improvement in 66-swollen joint count; and 3. ≥ 70% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).

Time frame: Baseline and week 14

Population: Full analysis set; participants who prematurely discontinued from study drug prior to Week 14 or for whom ACR data were missing at Week 14 were considered non-responders.

ArmMeasureValue (NUMBER)
MethotrexatePercentage of Participants With an American College of Rheumatology 70% (ACR70) Response at Week 142.8 percentage of participants
Upadacitinib 15 mgPercentage of Participants With an American College of Rheumatology 70% (ACR70) Response at Week 1422.6 percentage of participants
Upadacitinib 30 mgPercentage of Participants With an American College of Rheumatology 70% (ACR70) Response at Week 1433.0 percentage of participants
p-value: <0.00195% CI: [13.8, 25.8]Cochran-Mantel-Haenszel
p-value: <0.00195% CI: [23.6, 36.9]Cochran-Mantel-Haenszel

Source: ClinicalTrials.gov · Data processed: Mar 6, 2026