Upadacitinib may be more effective in control of pain, which may be due to either inflammatory or noninflammatory mechanisms, than adalimumab among patients with rheumatoid arthritis (RA), according to Peter C Taylor, PhD, during his presentation at the ACR Convergence on November 12.

Dr Taylor is the Norman Collisson professor of musculoskeletal sciences at the University of Oxford in Oxford, United Kingdom.

“Both upadacitinib and adalimumab resulted in rapid and significant improvements in pain vs placebo as early as week 2 in patients with RA,” Dr Taylor said in discussing the findings of the SELECT-COMPARE trial. However, at week 12 and week 26, the direct effect on pain was “up to 2 times greater with upadacitinib versus adalimumab,” suggesting that upadacitinib is more effective in pain management for patients with RA.

For the 48-week, randomized, double-blind, phase 3 study, adults more than 18 years of age who had active disease despite methotrexate treatment were randomized to 2:2:1 to upadacitinib 15 mg once daily (n=651), placebo (n=651), or adalimumab 40 mg every other week (n=327).

The Patient’s Global Assessment of pain significantly improved with upadacitinib vs placebo from baseline to week 2 (–18.0 vs –7.5; P< 0.001), week 12 (–32.1  vs –15.7; P< 0.001), and week 26 (–41.4 vs –30.8; P< 0.001). The investigators observed a similar improvement in pain with adalimumab vs placebo.

However, for the indirect effects on pain assessed by tender-joint count-28 index, “upadacitinib showed a greater improvement in pain at weeks 12 and 26 than adalimumab.”

“Rapid and sustained pain control is an important goal for patients with RA,” Dr Taylor said. “Through this trial, we assessed direct and indirect effects of treatments on pain among these patients.”

Reference:
Taylor P. 0429: Direct and indirect effects of upadacitinib or adalimumab on pain in rheumatoid arthritis: Results from a randomized phase 3 study. Presented at: American College of Rheumatology Convergence. November 12, 2023. San Diego.