Skip to content

A Study to Evaluate Efficacy and Safety of Upadacitinib in Adults With Axial Spondyloarthritis

A Phase 3 Randomized, Placebo-Controlled, Double-Blind Program to Evaluate Efficacy and Safety of Upadacitinib in Adult Subjects With Axial Spondyloarthritis Followed by a Remission-Withdrawal Period

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04169373
Acronym
SELECT-AXIS 2
Enrollment
734
Registered
2019-11-19
Start date
2019-11-26
Completion date
2025-02-28
Last updated
2026-02-24

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

Conditions

Spondyloarthritis

Keywords

Upadacitinib, Axial Spondyloarthritis (axSpA), Spondyloarthritis, Ankylosing Spondylitis (AS)

Brief summary

This protocol includes 2 standalone studies with randomization, data collection, analysis and reporting conducted independently. The main objectives of this protocol are: * To evaluate the efficacy of upadacitinib compared with placebo on reduction of signs and symptoms in adults with active axial spondyloarthritis (axSpA) including biologic disease-modifying antirheumatic drug inadequate responders (bDMARD-IR) ankylosing spondylitis (AS) (Study 1) and non-radiographic axial spondyloarthritis (nr-axSpA) (Study 2). * To assess the safety and tolerability of upadacitinib in adults with active axSpA including bDMARD-IR AS (Study 1) and nr-axSpA (Study 2). * To evaluate the safety and tolerability of upadacitinib in extended treatment in adult participants with active axSpA including bDMARD-IR AS who have completed the Double-Blind Period (Study 1) and nr-axSpA who have completed the Double-Blind Period (Study 2). * To evaluate the maintenance of disease control after withdrawal of upadacitinib.

Detailed description

Study 1 (bDMARD-IR AS) is comprised of a 14-week randomized, double-blind, parallel-group, placebo-controlled period (the Double-Blind Period); a 90-week open-label, long-term extension period (the Open-Label Extension Period); and a 30-day Follow-Up Visit (F/U Visit). Study 2 (nr-axSpA) is comprised of a 52-week randomized, double-blind, parallel-group, placebo-controlled period (the Double-Blind Period); a 52-week open-label, long-term extension period (the Open-Label Extension Period); and a 30-day F/U Visit. In the Double-Blind Period for both studies, participants are randomized in a 1:1 ratio to receive either upadacitinib or placebo once daily (QD). Participants in the placebo group switch to upadacitinib 15 mg QD at Week 14 in the Open-Label Extension Period for Study 1 (bDMARD-IR AS) and Week 52 in the Open-Label Extension Period for Study 2 (nr-axSpA). Participants in remission at Week 104 have the option to enroll in a remission-withdrawal period. Study M19-944 protocol uses a common screening platform for determining eligibility into Study 1 and Study 2. Each study has its own objectives, hypothesis testing, randomization, data collection, and adequate power for primary and secondary endpoints. Analysis and reporting are conducted separately and independently for each study.

Interventions

DRUGUpadacitinib

Upadacitinib tablet administered orally

DRUGPlacebo

Placebo for upadacitinib tablet administered orally

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 No maximum
Healthy volunteers
No

Inclusion criteria

* Study 1: * Must have a clinical diagnosis of ankylosing spondylitis (AS) and meet the modified New York Criteria for AS, * Must not have total spinal ankylosis * Must have been previously exposed to 1 or 2 bDMARDs (at least 1 tumor necrosis factor \[TNF\] inhibitor or 1 interleukin \[IL\]-17 inhibitor \[IL-17i\]), and must have discontinued the bDMARD therapy due to either lack of efficacy (after at least 12 weeks of treatment with a bDMARD at an adequate dose) or intolerance (irrespective of treatment duration). Prior exposure to two bDMARDs was allowed for no more than 30% of patients; among patients with prior exposure to two bDMARDs, a lack of efficacy to one bDMARD and intolerance to another was permitted, but a patient could not have a lack of efficacy to two bDMARDs * Study 2: * Must have a clinical diagnosis of nr-axSpA fulfilling the 2009 Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA but not meeting the radiologic criterion of the modified New York criteria for AS * Must have objective signs of active inflammation consistent with axSpA on magnetic resonance imaging (MRI) of sacroiliac (SI) joints or based on high sensitivity C-reactive protein (hsCRP) \> the upper limit of normal (ULN). * Prior treatment with at most one bDMARD (either TNF inhibitor or IL-17i) is allowed for at least 20% but no more than 35% of enrolled patients who had to discontinue the prior bDMARD due to either lack of efficacy (after ≥ 12 weeks at an adequate dose) or intolerance (regardless of treatment duration). * Must have a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score ≥ 4 at the Screening and Baseline Visits. * Must have a Total Back Pain score ≥ 4 based on a 0 - 10 numerical rating scale at the Screening and Baseline Visits. * Has had an inadequate response to at least 2 nonsteroidal anti-inflammatory drugs (NSAIDs) over an at least 4-week period in total at maximum recommended or tolerated doses, or has an intolerance to or contraindication for NSAIDs as defined by the Investigator.

Exclusion criteria

* Must not have been exposed to any Janus kinase (JAK) inhibitor (including but not limited to upadacitinib \[Rinvoq®\], tofacitinib \[Xeljanz®\], baricitinib \[Olumiant®\], filgotinib, ruxolitinib \[Jakafi®\], abrocitinib \[PF-04965842\], and peficitinib \[Smyraf®\]). * Prior bDMARD therapy must be washed out. * Participant must not have a history of an allergic reaction or significant sensitivity to constituents of the study drug.

Design outcomes

Primary

MeasureTime frameDescription
Study 1: Percentage of Participants Achieving Assessment of SpondyloArthritis International Society 40 (ASAS40) Response at Week 14Baseline and Week 14ASAS40 response was defined as improvement of ≥ 40% relative to Baseline and absolute improvement of ≥ 2 units (on a scale from 0 to 10) in ≥ 3 of the following 4 domains with no deterioration (defined as a net worsening of \> 0 units) in the potential remaining domain: * Patient's global assessment of disease activity, measured on a numeric rating scale (NRS) from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related Bath AS Disease Activity Index (BASDAI) NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).
Study 2: Percentage of Participants Achieving an ASAS40 Response at Week 14Baseline and Week 14ASAS40 response was defined as improvement of ≥ 40% relative to Baseline and absolute improvement of ≥ 2 units (on a scale from 0 to 10) in ≥ 3 of the following 4 domains with no deterioration (defined as a net worsening of \> 0 units) in the potential remaining domain: * Patient's global assessment of disease activity, measured on a numeric rating scale (NRS) from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related Bath AS Disease Activity Index (BASDAI) NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).

Secondary

MeasureTime frameDescription
Study 1: Change From Baseline in Ankylosing Spondylitis Disease Activity Score (ASDAS) at Week 14Baseline and Week 14ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score; published ranges for disease activity states as defined by the ASDAS include Inactive disease (ASDAS \< 1.3) and very high disease (ASDAS \> 3.5). A negative change from Baseline score indicates improvement in disease activity.
Study 1: Change From Baseline in Ankylosing Spondylitis Quality of Life (ASQoL) Score at Week 14Baseline and Week 14The ASQoL consists of 18 items related to quality of life, including the impact of pain on sleep, mood, motivation, ability to cope, activities of daily living, independence, relationships, and social life. Each item is answered as yes (scored as 1) or no (scored as 0). Scores are summed to obtain the overall score which ranges from 0 to 18, where higher scores indicate a worse quality of life. A negative change from Baseline in ASQoL indicates improvement in quality of life.
Study 1: Change From Baseline in Magnetic Resonance Imaging (MRI) Spondyloarthritis Research Consortium of Canada (SPARCC) Score for the Spine at Week 14Baseline and Week 14In the SPARCC MRI assessment of the spine, the entire spine was evaluated for active inflammation (bone marrow edema). Six discovertebral units (DVU) representing the 6 most abnormal DVUs were selected to calculate the MRI Spine SPARCC score. For each of the 6 DVUs, 3 consecutive sagittal slices were assessed in 4 quadrants to evaluate the extent of inflammation in all three dimensions. Each quadrant was scored for the presence (1) or absence (0) of edema. If edema was present in at least one quadrant of a DVU slice, it was also scored for intensity and depth of the edema representing that slice: An additional score of 1 was assigned if an intense signal was seen in any quadrant on a DVU slice. Slices that included a lesion demonstrating continuous increased signal of depth ≥ 1 cm extending from the endplate were scored as an additional 1 per slice. The maximum (worst) overall score for all 6 DVUs is 108. A negative change from Baseline indicates improvement.
Study 1: Percentage of Participants With Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50 Response at Week 14Baseline and Week 14The BASDAI assesses disease activity by asking the participant to answer 6 questions (each on an 11 point numeric rating scale \[NRS\]) pertaining to symptoms experienced for the past week. For Questions 1 to 5 (level of fatigue/tiredness, level of AS neck, back or hip pain, level of pain/swelling in joints, other than neck, back or hips, level of discomfort from any areas tender to touch or pressure, and level of morning stiffness), the response is from 0 (none) to 10 (very severe); for Question 6 (duration of morning stiffness), the response is from 0 (0 hours) to 10 (≥ 2 hours). The overall BASDAI score ranges from 0 to 10. Lower scores indicate less disease activity. A BASDAI 50 response is defined as improvement of 50% or more from Baseline in BASDAI score.
Study 1: Percentage of Participants With an ASAS20 Response at Week 14Baseline and Week 14ASAS20 response was defined as an improvement of ≥ 20% and an absolute improvement of ≥ 1 unit (on a scale of 0 to 10) from Baseline in at least 3 of the following 4 domains, with no deterioration (defined as a worsening of ≥ 20% and a net worsening of ≥ 1 units \[on a scale of 0 to 10\]) in the remaining domain: * Patient's global assessment of disease activity, measured on a NRS from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the BASFI which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related BASDAI NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).
Study 1: Percentage of Participants With ASDAS Inactive Disease at Week 14Week 14ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score. ASDAS Inactive Disease is defined as an ASDAS score \< 1.3.
Study 1: Change From Baseline in Patient's Assessment of Total Back Pain at Week 14Baseline and Week 14Participants assessed their total back pain during the last week on a 0 to 10 numerical rating scale (NRS), where 0 represents no pain and 10 represents most severe pain.
Study 1: Change From Baseline in Patient's Assessment of Nocturnal Back Pain at Week 14Baseline and Week 14Participants assessed the amount of back pain at night over the last week on a 0 to 10 NRS, where 0 represents no pain and 10 represents most severe pain.
Study 1: Percentage of Participants With ASDAS Low Disease Activity at Week 14Week 14ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score. ASDAS Low Disease Activity is defined as an ASDAS score \< 2.1.
Study 1: Change From Baseline in Bath Ankylosing Spondylitis Functional Index (BASFI) at Week 14Baseline and Week 14The Bath Ankylosing Spondylitis Functional Index is a validated index to determine the degree of functional limitation in patients with AS. BASFI consists of 10 questions assessing participants' ability to perform activities such as putting on socks, bending, reaching, getting up from the floor or an armless chair, standing, climbing and other physical activities. Each item is scored on a NRS ranging from 0 (easy to perform an activity) to 10 (impossible to perform an activity). The overall score is the mean of the 10 items and ranges from 0 to 10 with higher scores indicating more functional limitations. A negative change from Baseline in BASFI indicates improvement.
Study 1: Percentage of Participants With ASAS Partial Remission at Week 14Week 14ASAS partial remission (PR) is defined as an absolute score of ≤ 2 units on a 0 to 10 scale for each of the four following domains: * Patient's global assessment of disease activity, measured on a numeric rating scale (NRS) from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related Bath AS Disease Activity Index (BASDAI) NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).
Study 1: Change From Baseline in ASAS Health Index at Week 14Baseline and Week 14The ASAS health index (HI) measures functioning and health across 17 aspects of health in patients with AS, including pain, emotional functions, sleep, sexual function, mobility, self care, and community life. Each of the 17 questions is answered by the participant as "I agree" (score = 1) or "I disagree" (score = 0). The responses to the 17 dichotomous items are summed up to give a total score ranging from 0 to 17, where a higher score indicates a worse health status. A negative change from Baseline indicates improvement.
Study 1: Change From Baseline in Linear Bath Ankylosing Spondylitis Metrology Index (BASMI[Lin]) at Week 14Baseline and Week 14The BASMI is a composite score based on 5 direct measurements of spinal mobility: 1. cervical rotation (measured in degrees), 2. tragus to wall distance (in centimeters \[cm\]) 3. lumbar side flexion (in cm), 4. lumbar flexion (modified Schober's) (in cm) and 5. intermalleolar distance (in cm). Each measurement is converted to a linear score between 0 and 10. The total BASMI(lin) score is the average of the 5 scores and ranges from 0 to 10; the higher the BASMI(lin) score the more severe the patient's limitation of movement due to their ankylosing spondylitis. A negative change from Baseline indicates improvement.
Study 1: Change From Baseline in Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) at Week 14Baseline and Week 14The MASES evaluation was conducted to assess the presence or absence of enthesitis (inflammation of the entheses, or sites where tendons or ligaments insert into the bone) at 13 different sites (first costochondral joint left/right, seventh costochondral joint left/right, posterior superior iliac spine left/right, anterior superior iliac spine left/right, iliac crest left/right, fifth lumbar spinous process, and proximal insertion of Achilles tendon left/right. Each site was scored for presence (1) or absence (0) of enthesitis. The MASES is the sum of the 13 site scores, and ranges from 0 to 13, with higher scores indicating more inflammation of the entheses. A negative change from Baseline indicates improvement.
Study 1: Change From Baseline in MRI SPARCC Score for Sacroiliac Joints at Week 14Baseline and Week 14In the SPARCC MRI assessment of the sacroiliac (SI) joints 6 consecutive sacroiliac joint image coronal slices representing the largest proportion of the synovial compartment of the SI joints were assessed for edema, intensity and depth of edema. Each SI joint (left and right) was divided into quadrants for a total of 8 SI scoring locations. Each quadrant was scored for the presence (1) or absence (0) of edema, intensity of edema (a score of 1 was assigned for each SI joint (left and right) if an intense signal was seen in any quadrant of that joint for each slice), and a lesion was graded as deep (score of 1) if there was homogeneous and unequivocal increase in signal extending over a depth of at least 1 cm from the articular surface of the SI joint in any quadrant. The total maximum (worst) score for all SI joints across 6 slices is 72. A negative change from Baseline indicates improvement.
Study 2: Change From Baseline in ASDAS at Week 14Baseline and Week 14ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score; published ranges for disease activity states as defined by the ASDAS include Inactive disease (ASDAS \< 1.3) and very high disease (ASDAS \> 3.5). A negative change from Baseline score indicates improvement in disease activity.
Study 2: Change From Baseline in MRI SPARCC Score for SI Joints at Week 14Baseline and Week 14In the SPARCC MRI assessment of the sacroiliac (SI) joints 6 consecutive sacroiliac joint image coronal slices representing the largest proportion of the synovial compartment of the SI joints were assessed for edema, intensity and depth of edema. Each SI joint (left and right) was divided into quadrants for a total of 8 SI scoring locations. Each quadrant was scored for the presence (1) or absence (0) of edema, intensity of edema (a score of 1 was assigned for each SI joint (left and right) if an intense signal was seen in any quadrant of that joint for each slice), and a lesion was graded as deep (score of 1) if there was homogeneous and unequivocal increase in signal extending over a depth of at least 1 cm from the articular surface of the SI joint in any quadrant. The total maximum (worst) score for all SI joints across 6 slices is 72. A negative change from Baseline indicates improvement.
Study 2: Percentage of Participants With BASDAI 50 Response at Week 14Baseline and Week 14The BASDAI assesses disease activity by asking the participant to answer 6 questions (each on an 11 point numeric rating scale \[NRS\]) pertaining to symptoms experienced for the past week. For Questions 1 to 5 (level of fatigue/tiredness, level of AS neck, back or hip pain, level of pain/swelling in joints, other than neck, back or hips, level of discomfort from any areas tender to touch or pressure, and level of morning stiffness), the response is from 0 (none) to 10 (very severe); for Question 6 (duration of morning stiffness), the response is from 0 (0 hours) to 10 (≥ 2 hours). The overall BASDAI score ranges from 0 to 10. Lower scores indicate less disease activity. A BASDAI 50 response is defined as improvement of 50% or more from Baseline in BASDAI score.
Study 2: Percentage of Participants With ASDAS Inactive Disease at Week 14Week 14ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score. ASDAS Inactive Disease is defined as an ASDAS score \< 1.3.
Study 2: Change From Baseline in Patient's Assessment of Total Back Pain at Week 14Baseline and Week 14Participants assessed their total back pain during the last week on a 0 to 10 numerical rating scale (NRS), where 0 represents no pain and 10 represents most severe pain.
Study 2: Change From Baseline in Patient's Assessment of Nocturnal Back Pain at Week 14Baseline and Week 14Participants assessed the amount of back pain at night over the last week on a 0 to 10 NRS, where 0 represents no pain and 10 represents most severe pain.
Study 2: Percentage of Participants With ASDAS Low Disease Activity at Week 14Week 14ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score. ASDAS Low Disease Activity is defined as an ASDAS score \< 2.1.
Study 2: Percentage of Participants With ASAS Partial Remission at Week 14Week 14ASAS partial remission (PR) is defined as an absolute score of ≤ 2 units on a 0 to 10 scale for each of the four following domains: * Patient's global assessment of disease activity, measured on a numeric rating scale (NRS) from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related Bath AS Disease Activity Index (BASDAI) NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).
Study 2: Change From Baseline in BASFI at Week 14Baseline and Week 14The Bath Ankylosing Spondylitis Functional Index is a validated index to determine the degree of functional limitation in patients with AS. BASFI consists of 10 questions assessing participants' ability to perform activities such as putting on socks, bending, reaching, getting up from the floor or an armless chair, standing, climbing and other physical activities. Each item is scored on a NRS ranging from 0 (easy to perform an activity) to 10 (impossible to perform an activity). The overall score is the mean of the 10 items and ranges from 0 to 10 with higher scores indicating more functional limitations. A negative change from Baseline in BASFI indicates improvement.
Study 2: Change From Baseline in ASQoL at Week 14Baseline and Week 14The ASQoL consists of 18 items related to quality of life, including the impact of pain on sleep, mood, motivation, ability to cope, activities of daily living, independence, relationships, and social life. Each item is answered as yes (scored as 1) or no (scored as 0). Scores are summed to obtain the overall score which ranges from 0 to 18, where higher scores indicate a worse quality of life. A negative change from Baseline in ASQoL indicates improvement in quality of life.
Study 2: Change From Baseline in ASAS Health Index at Week 14Baseline and Week 14The ASAS HI measures functioning and health across 17 aspects of health in patients with AS, including pain, emotional functions, sleep, sexual function, mobility, self care, and community life. Each of the 17 questions is answered by the participant as "I agree" (score = 1) or "I disagree" (score = 0). The responses to the 17 dichotomous items are summed up to give a total score ranging from 0 to 17, where a higher score indicates a worse health status. A negative change from Baseline indicates improvement.
Study 2: Percentage of Participants Achieving an ASAS20 Response at Week 14Baseline and Week 14ASAS20 response was defined as an improvement of ≥ 20% and an absolute improvement of ≥ 1 unit (on a scale of 0 to 10) from Baseline in at least 3 of the following 4 domains, with no deterioration (defined as a worsening of ≥ 20% and a net worsening of ≥ 1 units \[on a scale of 0 to 10\]) in the remaining domain: * Patient's global assessment of disease activity, measured on a NRS from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the BASFI which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related BASDAI NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).
Study 2: Change From Baseline in BASMI(Lin) at Week 14Baseline and Week 14The BASMI is a composite score based on 5 direct measurements of spinal mobility: 1. cervical rotation (measured in degrees), 2. tragus to wall distance (in centimeters \[cm\]) 3. lumbar side flexion (in cm), 4. lumbar flexion (modified Schober's) (in cm) and 5. intermalleolar distance (in cm). Each measurement is converted to a linear score between 0 and 10. The total BASMI(lin) score is the average of the 5 scores and ranges from 0 to 10; the higher the BASMI(lin) score the more severe the patient's limitation of movement due to their ankylosing spondylitis. A negative change from Baseline indicates improvement.
Study 2: Change From Baseline in MASES at Week 14Baseline and Week 14The MASES evaluation was conducted to assess the presence or absence of enthesitis (inflammation of the entheses, or sites where tendons or ligaments insert into the bone) at 13 different sites (first costochondral joint left/right, seventh costochondral joint left/right, posterior superior iliac spine left/right, anterior superior iliac spine left/right, iliac crest left/right, fifth lumbar spinous process, and proximal insertion of Achilles tendon left/right. Each site was scored for presence (1) or absence (0) of enthesitis. The MASES is the sum of the 13 site scores, and ranges from 0 to 13, with higher scores indicating more inflammation of the entheses. A negative change from Baseline indicates improvement.
Study 2: Percentage of Participants Achieving an ASAS40 Response at Week 52Baseline and Week 52ASAS40 response was defined as improvement of ≥ 40% relative to Baseline and absolute improvement of ≥ 2 units (on a scale from 0 to 10) in ≥ 3 of the following 4 domains with no deterioration (defined as a net worsening of \> 0 units) in the potential remaining domain: * Patient's global assessment of disease activity, measured on a numeric rating scale (NRS) from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related Bath AS Disease Activity Index (BASDAI) NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).
Study 2: Change From Baseline in MRI SPARCC Score for the Spine at Week 14Baseline and Week 14In the SPARCC MRI assessment of the spine, the entire spine is evaluated for active inflammation (bone marrow edema). Six discovertebral units (DVU) representing the 6 most abnormal DVUs were selected to calculate the MRI Spine SPARCC score. For each of the 6 DVUs, 3 consecutive sagittal slices were assessed in 4 quadrants to evaluate the extent of inflammation in all three dimensions. Each quadrant was scored for the presence (1) or absence (0) of edema. If edema was present in at least one quadrant of a DVU slice, it was also scored for intensity and depth of the edema representing that slice: An additional score of 1 was assigned if an intense signal was seen in any quadrant on a DVU slice. Slices that included a lesion demonstrating continuous increased signal of depth ≥ 1 cm extending from the endplate were scored as an additional 1 per slice. The maximum (worst) overall score for all 6 DVUs is 108. A negative change from Baseline indicates improvement.
Study 2: Percentage of Participants Who Initiated Rescue Treatment Between Week 24 and Week 52Week 24, Week 32, Week 40, and Week 52Participants who did not achieve an ASAS20 response at any 2 consecutive scheduled visits from Week 24 through Week 52 were to be rescued with standard of care treatment as described in the protocol.
Study 2: Percentage of Participants With ASDAS Major Improvement at Week 52Baseline and Week 52ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score; published ranges for disease activity states as defined by the ASDAS include Inactive disease (ASDAS \< 1.3) and very high disease (ASDAS \> 3.5). Major Improvement is defined as a change from Baseline of ≤ -2.0.
Study 2: Percentage of Participants With ASDAS Inactive Disease at Week 52Week 52ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score. ASDAS Inactive Disease is defined as an ASDAS score \< 1.3.
Study 2: Percentage of Participants With ASDAS Low Disease Activity at Week 52Week 52ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score. ASDAS Low Disease Activity is defined as an ASDAS score \< 2.1.

Countries

Argentina, Australia, Belgium, Brazil, Bulgaria, Canada, China, Czechia, France, Germany, Hungary, Israel, Japan, Mexico, New Zealand, Poland, Russia, Slovakia, South Korea, Spain, Taiwan, Turkey (Türkiye), Ukraine, United Kingdom, United States

Contacts

STUDY_DIRECTORABBVIE INC.

AbbVie

Participant flow

Recruitment details

This master protocol consists of 2 independent studies with a common screening platform for adults with active axial spondyloarthritis (axSpA). Study 1 enrolled adults with ankylosing spondylitis (AS) who had an inadequate response (IR) to biologic disease-modifying antirheumatic drug (bDMARD) therapy. Study 2 enrolled adults with non-radiographic axSpA (nr-axSpA). Each study includes a double-blind treatment period and an ongoing open-label extension period. RW period entry was optional.

Pre-assignment details

In each study participants were randomized equally to one of two treatment groups. In Study 1 randomization was stratified by high-sensitivity C-reactive protein (hsCRP) at Screening, class of the prior bDMARD use, and geographic region. In Study 2 randomization was stratified by magnetic resonance imaging (MRI) and Screening hsCRP status, and exposure to bDMARDs. For both studies Japan and China each had a separate randomization schedule stratified by Screening hsCRP and MRI (Study 2 only).

Participants by arm

ArmCount
Study 1: Placebo
Participants with bDMARD-IR AS received placebo tablets orally once a day for 14 weeks. At Week 14 participants switched to receive 15 mg upadacitinib once daily in the open-label extension period.
209
Study 1: Upadacitinib 15 mg
Participants with bDMARD-IR AS received 15 mg upadacitinib orally once a day for 14 weeks and continued to receive 15 mg upadacitinib once daily from Week 14 in the open-label extension period.
211
Study 2: Placebo
Participants with nr-axSpA received placebo tablets orally once a day for 52 weeks.
157
Study 2: Upadacitinib 15 mg
Participants with nr-axSpA received 15 mg upadacitinib orally once a day for 52 weeks.
156
Total733

Baseline characteristics

CharacteristicStudy 1: PlaceboStudy 1: Upadacitinib 15 mgTotalStudy 2: PlaceboStudy 2: Upadacitinib 15 mg
Age, Continuous
Study 1
42.2 years
STANDARD_DEVIATION 11.78
42.6 years
STANDARD_DEVIATION 12.39
42.4 years
STANDARD_DEVIATION 12.08
Age, Continuous
Study 2
42.1 years
STANDARD_DEVIATION 12.21
42.5 years
STANDARD_DEVIATION 12.44
41.6 years
STANDARD_DEVIATION 12
Age, Customized
Study 1
40 - < 65 years
108 Participants112 Participants220 Participants
Age, Customized
Study 1
< 40 years
92 Participants87 Participants179 Participants
Age, Customized
Study 1
≥ 65 years
9 Participants12 Participants21 Participants
Age, Customized
Study 2
40 - < 65 years
165 Participants84 Participants81 Participants
Age, Customized
Study 2
< 40 years
139 Participants67 Participants72 Participants
Age, Customized
Study 2
≥ 65 years
9 Participants6 Participants3 Participants
Bath Ankylosing Spondylitis Functional Index
Study 1
6.2 score on a scale
STANDARD_DEVIATION 1.87
6.3 score on a scale
STANDARD_DEVIATION 2.03
6.2 score on a scale
STANDARD_DEVIATION 1.95
Bath Ankylosing Spondylitis Functional Index
Study 2
5.9 score on a scale
STANDARD_DEVIATION 2.11
6.0 score on a scale
STANDARD_DEVIATION 2.14
5.9 score on a scale
STANDARD_DEVIATION 2.08
Duration of AS / nr-axSpA Symptoms
Study 1 -Duration of AS symptoms
12.6 years
STANDARD_DEVIATION 9.29
12.9 years
STANDARD_DEVIATION 9.08
12.8 years
STANDARD_DEVIATION 9.18
Duration of AS / nr-axSpA Symptoms
Study 2 - Duration of nr-axSpA symptoms
9.1 years
STANDARD_DEVIATION 7.98
9.2 years
STANDARD_DEVIATION 8.12
9.0 years
STANDARD_DEVIATION 7.86
Ethnicity (NIH/OMB)
Study 1
Hispanic or Latino
20 Participants17 Participants37 Participants
Ethnicity (NIH/OMB)
Study 1
Not Hispanic or Latino
189 Participants194 Participants383 Participants
Ethnicity (NIH/OMB)
Study 1
Unknown or Not Reported
0 Participants0 Participants0 Participants
Ethnicity (NIH/OMB)
Study 2
Hispanic or Latino
39 Participants15 Participants24 Participants
Ethnicity (NIH/OMB)
Study 2
Not Hispanic or Latino
274 Participants142 Participants132 Participants
Ethnicity (NIH/OMB)
Study 2
Unknown or Not Reported
0 Participants0 Participants0 Participants
High-sensitivity C-reactive Protein (hsCRP) Level at Screening
Study 1
≤ upper limit of normal
46 Participants46 Participants92 Participants
High-sensitivity C-reactive Protein (hsCRP) Level at Screening
Study 1
> upper limit of normal
163 Participants165 Participants328 Participants
High-sensitivity C-reactive Protein (hsCRP) Level at Screening
Study 2
≤ upper limit of normal
64 Participants31 Participants33 Participants
High-sensitivity C-reactive Protein (hsCRP) Level at Screening
Study 2
> upper limit of normal
249 Participants126 Participants123 Participants
Inflammation
Study 1
6.8 score on a scale
STANDARD_DEVIATION 1.55
6.9 score on a scale
STANDARD_DEVIATION 1.84
6.8 score on a scale
STANDARD_DEVIATION 1.7
Inflammation
Study 2
6.6 score on a scale
STANDARD_DEVIATION 1.75
6.7 score on a scale
STANDARD_DEVIATION 1.67
6.6 score on a scale
STANDARD_DEVIATION 1.83
Patient's Assessment of Total Back Pain
Study 1
7.4 units on a scale
STANDARD_DEVIATION 1.43
7.5 units on a scale
STANDARD_DEVIATION 1.48
7.4 units on a scale
STANDARD_DEVIATION 1.46
Patient's Assessment of Total Back Pain
Study 2
7.3 units on a scale
STANDARD_DEVIATION 1.47
7.3 units on a scale
STANDARD_DEVIATION 1.39
7.2 units on a scale
STANDARD_DEVIATION 1.55
Patient's Global Assessment of Disease Activity (PtGA)
Study 1
7.2 units on a scale
STANDARD_DEVIATION 1.4
7.4 units on a scale
STANDARD_DEVIATION 1.48
7.3 units on a scale
STANDARD_DEVIATION 1.44
Patient's Global Assessment of Disease Activity (PtGA)
Study 2
7.1 units on a scale
STANDARD_DEVIATION 1.51
7.3 units on a scale
STANDARD_DEVIATION 1.38
7.0 units on a scale
STANDARD_DEVIATION 1.62
Race (NIH/OMB)
Study 1
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Study 1
Asian
37 Participants42 Participants79 Participants
Race (NIH/OMB)
Study 1
Black or African American
3 Participants1 Participants4 Participants
Race (NIH/OMB)
Study 1
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Study 1
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Study 1
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Study 1
White
169 Participants168 Participants337 Participants
Race (NIH/OMB)
Study 2
American Indian or Alaska Native
1 Participants0 Participants1 Participants
Race (NIH/OMB)
Study 2
Asian
47 Participants28 Participants19 Participants
Race (NIH/OMB)
Study 2
Black or African American
3 Participants1 Participants2 Participants
Race (NIH/OMB)
Study 2
More than one race
1 Participants1 Participants0 Participants
Race (NIH/OMB)
Study 2
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Study 2
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Study 2
White
261 Participants127 Participants134 Participants
Region
Study 1
Asia
34 Participants41 Participants75 Participants
Region
Study 1
Eastern Europe
98 Participants109 Participants207 Participants
Region
Study 1
North America
25 Participants25 Participants50 Participants
Region
Study 1
Other
13 Participants7 Participants20 Participants
Region
Study 1
South/Central America
14 Participants13 Participants27 Participants
Region
Study 1
Western Europe
25 Participants16 Participants41 Participants
Region
Study 2
Asia
46 Participants27 Participants19 Participants
Region
Study 2
Eastern Europe
140 Participants72 Participants68 Participants
Region
Study 2
North America
45 Participants19 Participants26 Participants
Region
Study 2
Other
14 Participants7 Participants7 Participants
Region
Study 2
South/Central America
25 Participants13 Participants12 Participants
Region
Study 2
Western Europe
43 Participants19 Participants24 Participants
Sex: Female, Male
Study 1
Female
51 Participants58 Participants109 Participants
Sex: Female, Male
Study 1
Male
158 Participants153 Participants311 Participants
Sex: Female, Male
Study 2
Female
183 Participants94 Participants89 Participants
Sex: Female, Male
Study 2
Male
130 Participants63 Participants67 Participants
SPARCC MRI Sacroiliac Joint Score
Study 1
5.6 score on a scale
STANDARD_DEVIATION 10.63
5.0 score on a scale
STANDARD_DEVIATION 10.8
5.3 score on a scale
STANDARD_DEVIATION 10.71
SPARCC MRI Sacroiliac Joint Score
Study 2
3.9 score on a scale
STANDARD_DEVIATION 8.18
3.5 score on a scale
STANDARD_DEVIATION 7.6
4.4 score on a scale
STANDARD_DEVIATION 8.74
Spondyloarthritis Research Consortium of Canada (SPARCC) MRI Spine Score
Study 1
8.8 score on a scale
STANDARD_DEVIATION 12.52
10.7 score on a scale
STANDARD_DEVIATION 15.43
9.7 score on a scale
STANDARD_DEVIATION 14.05
Spondyloarthritis Research Consortium of Canada (SPARCC) MRI Spine Score
Study 2
2.1 score on a scale
STANDARD_DEVIATION 5.52
1.4 score on a scale
STANDARD_DEVIATION 3.72
2.7 score on a scale
STANDARD_DEVIATION 6.88
Study 1: Class of Prior bDMARD Use
Missing (no prior bDMARD use)
1 Participants0 Participants1 Participants
Study 1: Class of Prior bDMARD Use
One interleukin-17 (IL-17) inhibitor
24 Participants29 Participants53 Participants
Study 1: Class of Prior bDMARD Use
One tumor necrosis factor (TNF) inhibitor
158 Participants154 Participants312 Participants
Study 1: Class of Prior bDMARD Use
Prior exposure to 2 bDMARDs
26 Participants28 Participants54 Participants
Study 2: Magnetic Resonance Imaging (MRI) Inflammation Status
MRI-negative
177 Participants91 Participants86 Participants
Study 2: Magnetic Resonance Imaging (MRI) Inflammation Status
MRI-positive
136 Participants66 Participants70 Participants
Study 2: MRI Inflammation and hsCRP Status
MRI negative and hsCRP > ULN
177 Participants91 Participants86 Participants
Study 2: MRI Inflammation and hsCRP Status
MRI positive and hsCRP ≤ ULN
63 Participants31 Participants32 Participants
Study 2: MRI Inflammation and hsCRP Status
MRI positive and hsCRP > ULN
73 Participants35 Participants38 Participants
Study 2: Prior bDMARD Use
No
210 Participants103 Participants107 Participants
Study 2: Prior bDMARD Use
Yes
103 Participants54 Participants49 Participants
Time Since AS / nr-axSpA Diagnosis
Study 1 - Duration since AS diagnosis
7.5 years
STANDARD_DEVIATION 7.51
7.9 years
STANDARD_DEVIATION 7.54
7.7 years
STANDARD_DEVIATION 7.52
Time Since AS / nr-axSpA Diagnosis
Study 2 - Duration since nr-axSpA diagnosis
4.4 years
STANDARD_DEVIATION 5.68
4.4 years
STANDARD_DEVIATION 5.83
4.5 years
STANDARD_DEVIATION 5.54

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
EG006
affected / at risk
EG007
affected / at risk
EG008
affected / at risk
EG009
affected / at risk
EG010
affected / at risk
EG011
affected / at risk
EG012
affected / at risk
EG013
affected / at risk
deaths
Total, all-cause mortality
0 / 2090 / 2111 / 4100 / 1580 / 1560 / 2710 / 30 / 50 / 930 / 520 / 180 / 230 / 660 / 61
other
Total, other adverse events
35 / 20941 / 211172 / 41069 / 15867 / 156107 / 2712 / 34 / 528 / 9319 / 524 / 186 / 2320 / 6622 / 61
serious
Total, serious adverse events
1 / 2096 / 21144 / 4106 / 1587 / 15622 / 2710 / 31 / 52 / 933 / 520 / 182 / 232 / 662 / 61

Outcome results

Primary

Study 1: Percentage of Participants Achieving Assessment of SpondyloArthritis International Society 40 (ASAS40) Response at Week 14

ASAS40 response was defined as improvement of ≥ 40% relative to Baseline and absolute improvement of ≥ 2 units (on a scale from 0 to 10) in ≥ 3 of the following 4 domains with no deterioration (defined as a net worsening of \> 0 units) in the potential remaining domain: * Patient's global assessment of disease activity, measured on a numeric rating scale (NRS) from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related Bath AS Disease Activity Index (BASDAI) NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).

Time frame: Baseline and Week 14

Population: Full analysis set; participants who discontinued study drug prior to Week 14 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation (MI).

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 1: Percentage of Participants Achieving Assessment of SpondyloArthritis International Society 40 (ASAS40) Response at Week 1418.2 percentage of participants
Study 1: Upadacitinib 15 mgStudy 1: Percentage of Participants Achieving Assessment of SpondyloArthritis International Society 40 (ASAS40) Response at Week 1444.5 percentage of participants
Comparison: Efficacy analyses and hypothesis testing including multiplicity adjustment were performed independently for Study 1 and Study 2.p-value: <0.000195% CI: [17.9, 34.9]Cochran-Mantel-Haenszel
Primary

Study 2: Percentage of Participants Achieving an ASAS40 Response at Week 14

ASAS40 response was defined as improvement of ≥ 40% relative to Baseline and absolute improvement of ≥ 2 units (on a scale from 0 to 10) in ≥ 3 of the following 4 domains with no deterioration (defined as a net worsening of \> 0 units) in the potential remaining domain: * Patient's global assessment of disease activity, measured on a numeric rating scale (NRS) from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related Bath AS Disease Activity Index (BASDAI) NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).

Time frame: Baseline and Week 14

Population: Full analysis set; participants who discontinued study drug prior to Week 14 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 2: Percentage of Participants Achieving an ASAS40 Response at Week 1422.5 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants Achieving an ASAS40 Response at Week 1444.9 percentage of participants
Comparison: Efficacy analyses and hypothesis testing including multiplicity adjustment were performed independently for Study 1 and Study 2.~Binary endpoints in Study 2 were analyzed using the Cochran-Mantel-Haenszel (CMH) test stratified by the main stratification factor of positivity for MRI inflammation in the sacroiliac joints and screening hsCRP status (MRI-positive and hsCRP \> ULN vs MRI-positive and hsCRP ≤ ULN vs MRI-negative and hsCRP \> ULN).p-value: <0.000195% CI: [12.1, 32.3]Cochran-Mantel-Haenszel
Comparison: A post-hoc logistic regression adjusting for the main stratification factor of MRI and screening hsCRP status was conducted for the multiplicity-controlled binary endpoints assessed at Week 14.95% CI: [1.7, 4.5]
Secondary

Study 1: Change From Baseline in Ankylosing Spondylitis Disease Activity Score (ASDAS) at Week 14

ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score; published ranges for disease activity states as defined by the ASDAS include Inactive disease (ASDAS \< 1.3) and very high disease (ASDAS \> 3.5). A negative change from Baseline score indicates improvement in disease activity.

Time frame: Baseline and Week 14

Population: Full analysis set participants with at least one available change from Baseline value; a mixed-effect model repeat measurement (MMRM) analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 1: Change From Baseline in Ankylosing Spondylitis Disease Activity Score (ASDAS) at Week 14-0.49 score on a scale
Study 1: Upadacitinib 15 mgStudy 1: Change From Baseline in Ankylosing Spondylitis Disease Activity Score (ASDAS) at Week 14-1.52 score on a scale
p-value: <0.000195% CI: [-1.2, -0.85]Mixed-effect Model Repeated Measurement
Secondary

Study 1: Change From Baseline in Ankylosing Spondylitis Quality of Life (ASQoL) Score at Week 14

The ASQoL consists of 18 items related to quality of life, including the impact of pain on sleep, mood, motivation, ability to cope, activities of daily living, independence, relationships, and social life. Each item is answered as yes (scored as 1) or no (scored as 0). Scores are summed to obtain the overall score which ranges from 0 to 18, where higher scores indicate a worse quality of life. A negative change from Baseline in ASQoL indicates improvement in quality of life.

Time frame: Baseline and Week 14

Population: Full analysis set participants with at least one available change from Baseline value; a mixed-effect model repeat measurement analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 1: Change From Baseline in Ankylosing Spondylitis Quality of Life (ASQoL) Score at Week 14-2.03 score on a scale
Study 1: Upadacitinib 15 mgStudy 1: Change From Baseline in Ankylosing Spondylitis Quality of Life (ASQoL) Score at Week 14-5.10 score on a scale
p-value: <0.000195% CI: [-3.9, -2.24]Mixed-effect Model Repeated Measurement
Secondary

Study 1: Change From Baseline in ASAS Health Index at Week 14

The ASAS health index (HI) measures functioning and health across 17 aspects of health in patients with AS, including pain, emotional functions, sleep, sexual function, mobility, self care, and community life. Each of the 17 questions is answered by the participant as I agree (score = 1) or I disagree (score = 0). The responses to the 17 dichotomous items are summed up to give a total score ranging from 0 to 17, where a higher score indicates a worse health status. A negative change from Baseline indicates improvement.

Time frame: Baseline and Week 14

Population: Full analysis set participants with at least one available change from Baseline value; a mixed-effect model repeat measurement analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 1: Change From Baseline in ASAS Health Index at Week 14-1.07 score on a scale
Study 1: Upadacitinib 15 mgStudy 1: Change From Baseline in ASAS Health Index at Week 14-2.93 score on a scale
p-value: <0.000195% CI: [-2.47, -1.24]Mixed-effect Model Repeated Measurement
Secondary

Study 1: Change From Baseline in Bath Ankylosing Spondylitis Functional Index (BASFI) at Week 14

The Bath Ankylosing Spondylitis Functional Index is a validated index to determine the degree of functional limitation in patients with AS. BASFI consists of 10 questions assessing participants' ability to perform activities such as putting on socks, bending, reaching, getting up from the floor or an armless chair, standing, climbing and other physical activities. Each item is scored on a NRS ranging from 0 (easy to perform an activity) to 10 (impossible to perform an activity). The overall score is the mean of the 10 items and ranges from 0 to 10 with higher scores indicating more functional limitations. A negative change from Baseline in BASFI indicates improvement.

Time frame: Baseline and Week 14

Population: Full analysis set participants with at least one available change from Baseline value; a mixed-effect model repeat measurement analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 1: Change From Baseline in Bath Ankylosing Spondylitis Functional Index (BASFI) at Week 14-1.09 score on a scale
Study 1: Upadacitinib 15 mgStudy 1: Change From Baseline in Bath Ankylosing Spondylitis Functional Index (BASFI) at Week 14-2.26 score on a scale
p-value: <0.000195% CI: [-1.55, -0.8]Mixed-effect Model Repeated Measurement
Secondary

Study 1: Change From Baseline in Linear Bath Ankylosing Spondylitis Metrology Index (BASMI[Lin]) at Week 14

The BASMI is a composite score based on 5 direct measurements of spinal mobility: 1. cervical rotation (measured in degrees), 2. tragus to wall distance (in centimeters \[cm\]) 3. lumbar side flexion (in cm), 4. lumbar flexion (modified Schober's) (in cm) and 5. intermalleolar distance (in cm). Each measurement is converted to a linear score between 0 and 10. The total BASMI(lin) score is the average of the 5 scores and ranges from 0 to 10; the higher the BASMI(lin) score the more severe the patient's limitation of movement due to their ankylosing spondylitis. A negative change from Baseline indicates improvement.

Time frame: Baseline and Week 14

Population: Full analysis set participants with available change from Baseline data

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 1: Change From Baseline in Linear Bath Ankylosing Spondylitis Metrology Index (BASMI[Lin]) at Week 14-0.16 score on a scale
Study 1: Upadacitinib 15 mgStudy 1: Change From Baseline in Linear Bath Ankylosing Spondylitis Metrology Index (BASMI[Lin]) at Week 14-0.48 score on a scale
p-value: <0.000195% CI: [-0.46, -0.18]ANCOVA
Secondary

Study 1: Change From Baseline in Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) at Week 14

The MASES evaluation was conducted to assess the presence or absence of enthesitis (inflammation of the entheses, or sites where tendons or ligaments insert into the bone) at 13 different sites (first costochondral joint left/right, seventh costochondral joint left/right, posterior superior iliac spine left/right, anterior superior iliac spine left/right, iliac crest left/right, fifth lumbar spinous process, and proximal insertion of Achilles tendon left/right. Each site was scored for presence (1) or absence (0) of enthesitis. The MASES is the sum of the 13 site scores, and ranges from 0 to 13, with higher scores indicating more inflammation of the entheses. A negative change from Baseline indicates improvement.

Time frame: Baseline and Week 14

Population: Full analysis set participants with Baseline enthesitis and at least one available change from Baseline value; a mixed-effect model repeat measurement analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 1: Change From Baseline in Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) at Week 14-1.1 score on a scale
Study 1: Upadacitinib 15 mgStudy 1: Change From Baseline in Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) at Week 14-2.6 score on a scale
p-value: <0.000195% CI: [-2, -0.9]Mixed-effect Model Repeated Measurement
Secondary

Study 1: Change From Baseline in Magnetic Resonance Imaging (MRI) Spondyloarthritis Research Consortium of Canada (SPARCC) Score for the Spine at Week 14

In the SPARCC MRI assessment of the spine, the entire spine was evaluated for active inflammation (bone marrow edema). Six discovertebral units (DVU) representing the 6 most abnormal DVUs were selected to calculate the MRI Spine SPARCC score. For each of the 6 DVUs, 3 consecutive sagittal slices were assessed in 4 quadrants to evaluate the extent of inflammation in all three dimensions. Each quadrant was scored for the presence (1) or absence (0) of edema. If edema was present in at least one quadrant of a DVU slice, it was also scored for intensity and depth of the edema representing that slice: An additional score of 1 was assigned if an intense signal was seen in any quadrant on a DVU slice. Slices that included a lesion demonstrating continuous increased signal of depth ≥ 1 cm extending from the endplate were scored as an additional 1 per slice. The maximum (worst) overall score for all 6 DVUs is 108. A negative change from Baseline indicates improvement.

Time frame: Baseline and Week 14

Population: Full analysis set participants with available change from Baseline data

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 1: Change From Baseline in Magnetic Resonance Imaging (MRI) Spondyloarthritis Research Consortium of Canada (SPARCC) Score for the Spine at Week 14-0.04 score on a scale
Study 1: Upadacitinib 15 mgStudy 1: Change From Baseline in Magnetic Resonance Imaging (MRI) Spondyloarthritis Research Consortium of Canada (SPARCC) Score for the Spine at Week 14-3.95 score on a scale
p-value: <0.000195% CI: [-5.47, -2.33]ANCOVA
Secondary

Study 1: Change From Baseline in MRI SPARCC Score for Sacroiliac Joints at Week 14

In the SPARCC MRI assessment of the sacroiliac (SI) joints 6 consecutive sacroiliac joint image coronal slices representing the largest proportion of the synovial compartment of the SI joints were assessed for edema, intensity and depth of edema. Each SI joint (left and right) was divided into quadrants for a total of 8 SI scoring locations. Each quadrant was scored for the presence (1) or absence (0) of edema, intensity of edema (a score of 1 was assigned for each SI joint (left and right) if an intense signal was seen in any quadrant of that joint for each slice), and a lesion was graded as deep (score of 1) if there was homogeneous and unequivocal increase in signal extending over a depth of at least 1 cm from the articular surface of the SI joint in any quadrant. The total maximum (worst) score for all SI joints across 6 slices is 72. A negative change from Baseline indicates improvement.

Time frame: Baseline and Week 14

Population: Full analysis set participants with available change from Baseline data.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 1: Change From Baseline in MRI SPARCC Score for Sacroiliac Joints at Week 141.05 score on a scale
Study 1: Upadacitinib 15 mgStudy 1: Change From Baseline in MRI SPARCC Score for Sacroiliac Joints at Week 14-2.26 score on a scale
p-value: <0.000195% CI: [-4.5, -2.12]ANCOVA
Secondary

Study 1: Change From Baseline in Patient's Assessment of Nocturnal Back Pain at Week 14

Participants assessed the amount of back pain at night over the last week on a 0 to 10 NRS, where 0 represents no pain and 10 represents most severe pain.

Time frame: Baseline and Week 14

Population: Full analysis set participants with at least one available change from Baseline value; a mixed-effect model repeat measurement analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 1: Change From Baseline in Patient's Assessment of Nocturnal Back Pain at Week 14-1.52 score on a scale
Study 1: Upadacitinib 15 mgStudy 1: Change From Baseline in Patient's Assessment of Nocturnal Back Pain at Week 14-3.21 score on a scale
p-value: <0.000195% CI: [-2.14, -1.24]Mixed-effect Model Repeated Measurement
Secondary

Study 1: Change From Baseline in Patient's Assessment of Total Back Pain at Week 14

Participants assessed their total back pain during the last week on a 0 to 10 numerical rating scale (NRS), where 0 represents no pain and 10 represents most severe pain.

Time frame: Baseline and Week 14

Population: Full analysis set participants with at least one available change from Baseline value; a mixed-effect model repeat measurement analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 1: Change From Baseline in Patient's Assessment of Total Back Pain at Week 14-1.47 score on a scale
Study 1: Upadacitinib 15 mgStudy 1: Change From Baseline in Patient's Assessment of Total Back Pain at Week 14-3.00 score on a scale
p-value: <0.000195% CI: [-1.96, -1.11]Mixed-effect Model Repeated Measurement
Secondary

Study 1: Percentage of Participants With an ASAS20 Response at Week 14

ASAS20 response was defined as an improvement of ≥ 20% and an absolute improvement of ≥ 1 unit (on a scale of 0 to 10) from Baseline in at least 3 of the following 4 domains, with no deterioration (defined as a worsening of ≥ 20% and a net worsening of ≥ 1 units \[on a scale of 0 to 10\]) in the remaining domain: * Patient's global assessment of disease activity, measured on a NRS from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the BASFI which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related BASDAI NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).

Time frame: Baseline and Week 14

Population: Full analysis set; participants who discontinued study drug prior to Week 14 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 1: Percentage of Participants With an ASAS20 Response at Week 1438.3 percentage of participants
Study 1: Upadacitinib 15 mgStudy 1: Percentage of Participants With an ASAS20 Response at Week 1465.4 percentage of participants
p-value: <0.000195% CI: [17.9, 36.3]Cochran-Mantel-Haenszel
Secondary

Study 1: Percentage of Participants With ASAS Partial Remission at Week 14

ASAS partial remission (PR) is defined as an absolute score of ≤ 2 units on a 0 to 10 scale for each of the four following domains: * Patient's global assessment of disease activity, measured on a numeric rating scale (NRS) from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related Bath AS Disease Activity Index (BASDAI) NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).

Time frame: Week 14

Population: Full analysis set; participants who discontinued study drug prior to Week 14 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 1: Percentage of Participants With ASAS Partial Remission at Week 144.3 percentage of participants
Study 1: Upadacitinib 15 mgStudy 1: Percentage of Participants With ASAS Partial Remission at Week 1417.5 percentage of participants
p-value: <0.000195% CI: [7.4, 19]Cochran-Mantel-Haenszel
Secondary

Study 1: Percentage of Participants With ASDAS Inactive Disease at Week 14

ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score. ASDAS Inactive Disease is defined as an ASDAS score \< 1.3.

Time frame: Week 14

Population: Full analysis set; participants who discontinued study drug prior to Week 14 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 1: Percentage of Participants With ASDAS Inactive Disease at Week 141.9 percentage of participants
Study 1: Upadacitinib 15 mgStudy 1: Percentage of Participants With ASDAS Inactive Disease at Week 1412.8 percentage of participants
p-value: <0.000195% CI: [6, 15.8]Cochran-Mantel-Haenszel
Secondary

Study 1: Percentage of Participants With ASDAS Low Disease Activity at Week 14

ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score. ASDAS Low Disease Activity is defined as an ASDAS score \< 2.1.

Time frame: Week 14

Population: Full analysis set; participants who discontinued study drug prior to Week 14 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 1: Percentage of Participants With ASDAS Low Disease Activity at Week 1410.1 percentage of participants
Study 1: Upadacitinib 15 mgStudy 1: Percentage of Participants With ASDAS Low Disease Activity at Week 1444.1 percentage of participants
p-value: <0.000195% CI: [26.2, 41.8]Cochran-Mantel-Haenszel
Secondary

Study 1: Percentage of Participants With Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50 Response at Week 14

The BASDAI assesses disease activity by asking the participant to answer 6 questions (each on an 11 point numeric rating scale \[NRS\]) pertaining to symptoms experienced for the past week. For Questions 1 to 5 (level of fatigue/tiredness, level of AS neck, back or hip pain, level of pain/swelling in joints, other than neck, back or hips, level of discomfort from any areas tender to touch or pressure, and level of morning stiffness), the response is from 0 (none) to 10 (very severe); for Question 6 (duration of morning stiffness), the response is from 0 (0 hours) to 10 (≥ 2 hours). The overall BASDAI score ranges from 0 to 10. Lower scores indicate less disease activity. A BASDAI 50 response is defined as improvement of 50% or more from Baseline in BASDAI score.

Time frame: Baseline and Week 14

Population: Full analysis set; participants who discontinued study drug prior to Week 14 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 1: Percentage of Participants With Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50 Response at Week 1416.7 percentage of participants
Study 1: Upadacitinib 15 mgStudy 1: Percentage of Participants With Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 50 Response at Week 1443.1 percentage of participants
p-value: <0.000195% CI: [18, 34.8]Cochran-Mantel-Haenszel
Secondary

Study 2: Change From Baseline in ASAS Health Index at Week 14

The ASAS HI measures functioning and health across 17 aspects of health in patients with AS, including pain, emotional functions, sleep, sexual function, mobility, self care, and community life. Each of the 17 questions is answered by the participant as I agree (score = 1) or I disagree (score = 0). The responses to the 17 dichotomous items are summed up to give a total score ranging from 0 to 17, where a higher score indicates a worse health status. A negative change from Baseline indicates improvement.

Time frame: Baseline and Week 14

Population: Full analysis set participants with at least one available change from Baseline value; a mixed-effect model repeat measurement analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 2: Change From Baseline in ASAS Health Index at Week 14-1.48 score on a scale
Study 1: Upadacitinib 15 mgStudy 2: Change From Baseline in ASAS Health Index at Week 14-3.26 score on a scale
p-value: <0.000195% CI: [-2.56, -1]Mixed-effect Model Repeated Measurement
Secondary

Study 2: Change From Baseline in ASDAS at Week 14

ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score; published ranges for disease activity states as defined by the ASDAS include Inactive disease (ASDAS \< 1.3) and very high disease (ASDAS \> 3.5). A negative change from Baseline score indicates improvement in disease activity.

Time frame: Baseline and Week 14

Population: Full analysis set participants with at least one available change from Baseline value; a mixed-effect model repeat measurement analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 2: Change From Baseline in ASDAS at Week 14-0.71 score on a scale
Study 1: Upadacitinib 15 mgStudy 2: Change From Baseline in ASDAS at Week 14-1.36 score on a scale
p-value: <0.000195% CI: [-0.85, -0.45]Mixed-effect Model Repeated Measurement
Secondary

Study 2: Change From Baseline in ASQoL at Week 14

The ASQoL consists of 18 items related to quality of life, including the impact of pain on sleep, mood, motivation, ability to cope, activities of daily living, independence, relationships, and social life. Each item is answered as yes (scored as 1) or no (scored as 0). Scores are summed to obtain the overall score which ranges from 0 to 18, where higher scores indicate a worse quality of life. A negative change from Baseline in ASQoL indicates improvement in quality of life.

Time frame: Baseline and Week 14

Population: Full analysis set participants with at least one available change from Baseline value; a mixed-effect model repeat measurement analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 2: Change From Baseline in ASQoL at Week 14-3.15 score on a scale
Study 1: Upadacitinib 15 mgStudy 2: Change From Baseline in ASQoL at Week 14-5.38 score on a scale
p-value: <0.000195% CI: [-3.26, -1.21]Mixed-effect Model Repeated Measurement
Secondary

Study 2: Change From Baseline in BASFI at Week 14

The Bath Ankylosing Spondylitis Functional Index is a validated index to determine the degree of functional limitation in patients with AS. BASFI consists of 10 questions assessing participants' ability to perform activities such as putting on socks, bending, reaching, getting up from the floor or an armless chair, standing, climbing and other physical activities. Each item is scored on a NRS ranging from 0 (easy to perform an activity) to 10 (impossible to perform an activity). The overall score is the mean of the 10 items and ranges from 0 to 10 with higher scores indicating more functional limitations. A negative change from Baseline in BASFI indicates improvement.

Time frame: Baseline and Week 14

Population: Full analysis set participants with at least one available change from Baseline value; a mixed-effect model repeat measurement analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 2: Change From Baseline in BASFI at Week 14-1.47 score on a scale
Study 1: Upadacitinib 15 mgStudy 2: Change From Baseline in BASFI at Week 14-2.61 score on a scale
p-value: <0.000195% CI: [-1.6, -0.68]Mixed-effect Model Repeated Measurement
Secondary

Study 2: Change From Baseline in BASMI(Lin) at Week 14

The BASMI is a composite score based on 5 direct measurements of spinal mobility: 1. cervical rotation (measured in degrees), 2. tragus to wall distance (in centimeters \[cm\]) 3. lumbar side flexion (in cm), 4. lumbar flexion (modified Schober's) (in cm) and 5. intermalleolar distance (in cm). Each measurement is converted to a linear score between 0 and 10. The total BASMI(lin) score is the average of the 5 scores and ranges from 0 to 10; the higher the BASMI(lin) score the more severe the patient's limitation of movement due to their ankylosing spondylitis. A negative change from Baseline indicates improvement.

Time frame: Baseline and Week 14

Population: Full analysis set participants with available change from Baseline data

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 2: Change From Baseline in BASMI(Lin) at Week 14-0.19 score on a scale
Study 1: Upadacitinib 15 mgStudy 2: Change From Baseline in BASMI(Lin) at Week 14-0.29 score on a scale
p-value: 0.178195% CI: [-0.25, 0.05]ANCOVA
Secondary

Study 2: Change From Baseline in MASES at Week 14

The MASES evaluation was conducted to assess the presence or absence of enthesitis (inflammation of the entheses, or sites where tendons or ligaments insert into the bone) at 13 different sites (first costochondral joint left/right, seventh costochondral joint left/right, posterior superior iliac spine left/right, anterior superior iliac spine left/right, iliac crest left/right, fifth lumbar spinous process, and proximal insertion of Achilles tendon left/right. Each site was scored for presence (1) or absence (0) of enthesitis. The MASES is the sum of the 13 site scores, and ranges from 0 to 13, with higher scores indicating more inflammation of the entheses. A negative change from Baseline indicates improvement.

Time frame: Baseline and Week 14

Population: Full analysis set participants with Baseline enthesitis and at least one available change from Baseline value; a mixed-effect model repeat measurement analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 2: Change From Baseline in MASES at Week 14-1.6 score on a scale
Study 1: Upadacitinib 15 mgStudy 2: Change From Baseline in MASES at Week 14-2.3 score on a scale
p-value: 0.019395% CI: [-1.3, -0.1]Mixed-effect Model Repeated Measurement
Secondary

Study 2: Change From Baseline in MRI SPARCC Score for SI Joints at Week 14

In the SPARCC MRI assessment of the sacroiliac (SI) joints 6 consecutive sacroiliac joint image coronal slices representing the largest proportion of the synovial compartment of the SI joints were assessed for edema, intensity and depth of edema. Each SI joint (left and right) was divided into quadrants for a total of 8 SI scoring locations. Each quadrant was scored for the presence (1) or absence (0) of edema, intensity of edema (a score of 1 was assigned for each SI joint (left and right) if an intense signal was seen in any quadrant of that joint for each slice), and a lesion was graded as deep (score of 1) if there was homogeneous and unequivocal increase in signal extending over a depth of at least 1 cm from the articular surface of the SI joint in any quadrant. The total maximum (worst) score for all SI joints across 6 slices is 72. A negative change from Baseline indicates improvement.

Time frame: Baseline and Week 14

Population: Full analysis set participants with available change from Baseline data

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 2: Change From Baseline in MRI SPARCC Score for SI Joints at Week 140.57 score on a scale
Study 1: Upadacitinib 15 mgStudy 2: Change From Baseline in MRI SPARCC Score for SI Joints at Week 14-2.49 score on a scale
p-value: <0.000195% CI: [-4.08, -2.04]ANCOVA
Secondary

Study 2: Change From Baseline in MRI SPARCC Score for the Spine at Week 14

In the SPARCC MRI assessment of the spine, the entire spine is evaluated for active inflammation (bone marrow edema). Six discovertebral units (DVU) representing the 6 most abnormal DVUs were selected to calculate the MRI Spine SPARCC score. For each of the 6 DVUs, 3 consecutive sagittal slices were assessed in 4 quadrants to evaluate the extent of inflammation in all three dimensions. Each quadrant was scored for the presence (1) or absence (0) of edema. If edema was present in at least one quadrant of a DVU slice, it was also scored for intensity and depth of the edema representing that slice: An additional score of 1 was assigned if an intense signal was seen in any quadrant on a DVU slice. Slices that included a lesion demonstrating continuous increased signal of depth ≥ 1 cm extending from the endplate were scored as an additional 1 per slice. The maximum (worst) overall score for all 6 DVUs is 108. A negative change from Baseline indicates improvement.

Time frame: Baseline and Week 14

Population: Full analysis set participants with available change from Baseline data

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 2: Change From Baseline in MRI SPARCC Score for the Spine at Week 140.34 score on a scale
Study 1: Upadacitinib 15 mgStudy 2: Change From Baseline in MRI SPARCC Score for the Spine at Week 14-0.79 score on a scale
p-value: 0.020695% CI: [-2.08, -0.17]ANCOVA
Secondary

Study 2: Change From Baseline in Patient's Assessment of Nocturnal Back Pain at Week 14

Participants assessed the amount of back pain at night over the last week on a 0 to 10 NRS, where 0 represents no pain and 10 represents most severe pain.

Time frame: Baseline and Week 14

Population: Full analysis set participants with at least one available change from Baseline value; a mixed-effect model repeat measurement analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 2: Change From Baseline in Patient's Assessment of Nocturnal Back Pain at Week 14-1.84 score on a scale
Study 1: Upadacitinib 15 mgStudy 2: Change From Baseline in Patient's Assessment of Nocturnal Back Pain at Week 14-2.96 score on a scale
p-value: 0.000195% CI: [-1.68, -0.55]Mixed-effect Model Repeated Measurement
Secondary

Study 2: Change From Baseline in Patient's Assessment of Total Back Pain at Week 14

Participants assessed their total back pain during the last week on a 0 to 10 numerical rating scale (NRS), where 0 represents no pain and 10 represents most severe pain.

Time frame: Baseline and Week 14

Population: Full analysis set participants with at least one available change from Baseline value; a mixed-effect model repeat measurement analysis including all observed data up to Week 14 was used.

ArmMeasureValue (LEAST_SQUARES_MEAN)
Study 1: PlaceboStudy 2: Change From Baseline in Patient's Assessment of Total Back Pain at Week 14-2.00 score on a scale
Study 1: Upadacitinib 15 mgStudy 2: Change From Baseline in Patient's Assessment of Total Back Pain at Week 14-2.91 score on a scale
p-value: 0.000495% CI: [-1.42, -0.41]Mixed-effect Model Repeated Measurement
Secondary

Study 2: Percentage of Participants Achieving an ASAS20 Response at Week 14

ASAS20 response was defined as an improvement of ≥ 20% and an absolute improvement of ≥ 1 unit (on a scale of 0 to 10) from Baseline in at least 3 of the following 4 domains, with no deterioration (defined as a worsening of ≥ 20% and a net worsening of ≥ 1 units \[on a scale of 0 to 10\]) in the remaining domain: * Patient's global assessment of disease activity, measured on a NRS from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the BASFI which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related BASDAI NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).

Time frame: Baseline and Week 14

Population: Full analysis set; participants who discontinued study drug prior to Week 14 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 2: Percentage of Participants Achieving an ASAS20 Response at Week 1443.8 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants Achieving an ASAS20 Response at Week 1466.7 percentage of participants
p-value: <0.000195% CI: [12.2, 33.4]Cochran-Mantel-Haenszel
Comparison: A post-hoc logistic regression adjusting for the main stratification factor of MRI and screening hsCRP status was conducted for the multiplicity-controlled binary endpoints assessed at Week 14.95% CI: [1.6, 4]
Secondary

Study 2: Percentage of Participants Achieving an ASAS40 Response at Week 52

ASAS40 response was defined as improvement of ≥ 40% relative to Baseline and absolute improvement of ≥ 2 units (on a scale from 0 to 10) in ≥ 3 of the following 4 domains with no deterioration (defined as a net worsening of \> 0 units) in the potential remaining domain: * Patient's global assessment of disease activity, measured on a numeric rating scale (NRS) from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related Bath AS Disease Activity Index (BASDAI) NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).

Time frame: Baseline and Week 52

Population: Full analysis set; participants who discontinued study drug prior to Week 52 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 2: Percentage of Participants Achieving an ASAS40 Response at Week 5242.7 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants Achieving an ASAS40 Response at Week 5262.8 percentage of participants
p-value: 0.000395% CI: [9.3, 30.9]Cochran-Mantel-Haenszel
Secondary

Study 2: Percentage of Participants Who Initiated Rescue Treatment Between Week 24 and Week 52

Participants who did not achieve an ASAS20 response at any 2 consecutive scheduled visits from Week 24 through Week 52 were to be rescued with standard of care treatment as described in the protocol.

Time frame: Week 24, Week 32, Week 40, and Week 52

Population: The analysis population is the Full Analysis Set, which includes all participants who were randomized and received at least one dose of study drug. Even though rescue was not assessed until after Week 24, the interpretation of the analysis is based on the percentage of participants who were rescued out of those who were randomized and received study drug, similar to the analysis of other binary endpoints.

ArmMeasureGroupValue (NUMBER)
Study 1: PlaceboStudy 2: Percentage of Participants Who Initiated Rescue Treatment Between Week 24 and Week 52Week 321.9 percentage of participants
Study 1: PlaceboStudy 2: Percentage of Participants Who Initiated Rescue Treatment Between Week 24 and Week 52Week 521.3 percentage of participants
Study 1: PlaceboStudy 2: Percentage of Participants Who Initiated Rescue Treatment Between Week 24 and Week 52Week 400.6 percentage of participants
Study 1: PlaceboStudy 2: Percentage of Participants Who Initiated Rescue Treatment Between Week 24 and Week 52Week 2413.4 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants Who Initiated Rescue Treatment Between Week 24 and Week 52Week 400.6 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants Who Initiated Rescue Treatment Between Week 24 and Week 52Week 323.2 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants Who Initiated Rescue Treatment Between Week 24 and Week 52Week 245.1 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants Who Initiated Rescue Treatment Between Week 24 and Week 52Week 520 percentage of participants
Secondary

Study 2: Percentage of Participants With ASAS Partial Remission at Week 14

ASAS partial remission (PR) is defined as an absolute score of ≤ 2 units on a 0 to 10 scale for each of the four following domains: * Patient's global assessment of disease activity, measured on a numeric rating scale (NRS) from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related Bath AS Disease Activity Index (BASDAI) NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).

Time frame: Week 14

Population: Full analysis set; participants who discontinued study drug prior to Week 14 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 2: Percentage of Participants With ASAS Partial Remission at Week 147.6 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants With ASAS Partial Remission at Week 1418.6 percentage of participants
p-value: 0.003595% CI: [3.6, 18.3]Cochran-Mantel-Haenszel
Comparison: A post-hoc logistic regression adjusting for the main stratification factor of MRI and screening hsCRP status was conducted for the multiplicity-controlled binary endpoints assessed at Week 14.95% CI: [1.3, 5.6]
Secondary

Study 2: Percentage of Participants With ASDAS Inactive Disease at Week 14

ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score. ASDAS Inactive Disease is defined as an ASDAS score \< 1.3.

Time frame: Week 14

Population: Full analysis set; participants who discontinued study drug prior to Week 14 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 2: Percentage of Participants With ASDAS Inactive Disease at Week 145.2 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants With ASDAS Inactive Disease at Week 1414.1 percentage of participants
p-value: 0.006395% CI: [2.5, 15.2]Cochran-Mantel-Haenszel
Comparison: A post-hoc logistic regression adjusting for the main stratification factor of MRI and screening hsCRP status was conducted for the multiplicity-controlled binary endpoints assessed at Week 14.95% CI: [1.3, 7]
Secondary

Study 2: Percentage of Participants With ASDAS Inactive Disease at Week 52

ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score. ASDAS Inactive Disease is defined as an ASDAS score \< 1.3.

Time frame: Week 52

Population: Full analysis set; participants who discontinued study drug prior to Week 52 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 2: Percentage of Participants With ASDAS Inactive Disease at Week 5210.8 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants With ASDAS Inactive Disease at Week 5232.7 percentage of participants
p-value: <0.000195% CI: [13.2, 30.6]Cochran-Mantel-Haenszel
Secondary

Study 2: Percentage of Participants With ASDAS Low Disease Activity at Week 14

ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score. ASDAS Low Disease Activity is defined as an ASDAS score \< 2.1.

Time frame: Week 14

Population: Full analysis set; participants who discontinued study drug prior to Week 14 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 2: Percentage of Participants With ASDAS Low Disease Activity at Week 1418.3 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants With ASDAS Low Disease Activity at Week 1442.3 percentage of participants
p-value: <0.000195% CI: [14.2, 33.4]Cochran-Mantel-Haenszel
Comparison: A post-hoc logistic regression adjusting for the main stratification factor of MRI and screening hsCRP status was conducted for the multiplicity-controlled binary endpoints assessed at Week 14.95% CI: [1.9, 5.4]
Secondary

Study 2: Percentage of Participants With ASDAS Low Disease Activity at Week 52

ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score. ASDAS Low Disease Activity is defined as an ASDAS score \< 2.1.

Time frame: Week 52

Population: Full analysis set; participants who discontinued study drug prior to Week 52 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 2: Percentage of Participants With ASDAS Low Disease Activity at Week 5232.5 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants With ASDAS Low Disease Activity at Week 5255.8 percentage of participants
p-value: <0.000195% CI: [12.4, 33.7]Cochran-Mantel-Haenszel
Secondary

Study 2: Percentage of Participants With ASDAS Major Improvement at Week 52

ASDAS is a composite index to assess disease activity in Ankylosing Spondylitis. ASDAS combines the following 5 disease activity variables using a weighted formula: 1. Patient's assessment of total back pain (BASDAI Question 2; NRS score 0 \[none\] - 10 \[very severe\]) 2. Patient global assessment of disease activity (NRS score 0 \[no activity\] - 10 \[severe activity\]) 3. Peripheral pain/swelling (BASDAI Question 3; NRS score 0 \[none\] - 10 \[very severe\]) 4. Duration of morning stiffness (BASDAI Question 6; NRS score 0 \[0 hours\] - 10 \[2 or more hours\]) 5. High-sensitivity C-reactive protein (hs-CRP) in mg/L. The overall score ranges from 0 with no defined upper score; published ranges for disease activity states as defined by the ASDAS include Inactive disease (ASDAS \< 1.3) and very high disease (ASDAS \> 3.5). Major Improvement is defined as a change from Baseline of ≤ -2.0.

Time frame: Baseline and Week 52

Population: Full analysis set; participants who discontinued study drug prior to Week 52 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 2: Percentage of Participants With ASDAS Major Improvement at Week 5220.4 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants With ASDAS Major Improvement at Week 5237.8 percentage of participants
p-value: 0.000495% CI: [7.9, 27.3]Cochran-Mantel-Haenszel
Secondary

Study 2: Percentage of Participants With BASDAI 50 Response at Week 14

The BASDAI assesses disease activity by asking the participant to answer 6 questions (each on an 11 point numeric rating scale \[NRS\]) pertaining to symptoms experienced for the past week. For Questions 1 to 5 (level of fatigue/tiredness, level of AS neck, back or hip pain, level of pain/swelling in joints, other than neck, back or hips, level of discomfort from any areas tender to touch or pressure, and level of morning stiffness), the response is from 0 (none) to 10 (very severe); for Question 6 (duration of morning stiffness), the response is from 0 (0 hours) to 10 (≥ 2 hours). The overall BASDAI score ranges from 0 to 10. Lower scores indicate less disease activity. A BASDAI 50 response is defined as improvement of 50% or more from Baseline in BASDAI score.

Time frame: Baseline and Week 14

Population: Full analysis set; participants who discontinued study drug prior to Week 14 or with missing data for reasons other than COVID-19 were counted as non-responders (non-responder imputation); Missing data due to COVID-19 infection or logistical restriction was handled by multiple imputation.

ArmMeasureValue (NUMBER)
Study 1: PlaceboStudy 2: Percentage of Participants With BASDAI 50 Response at Week 1422.1 percentage of participants
Study 1: Upadacitinib 15 mgStudy 2: Percentage of Participants With BASDAI 50 Response at Week 1442.3 percentage of participants
p-value: 0.000195% CI: [10.1, 30.1]Cochran-Mantel-Haenszel
Comparison: A post-hoc logistic regression adjusting for the main stratification factor of MRI and screening hsCRP status was conducted for the multiplicity-controlled binary endpoints assessed at Week 14.95% CI: [1.6, 4.2]

Source: ClinicalTrials.gov · Data processed: Mar 15, 2026