Ryan DeMasi, MD: Upadacitinib Monotherapy Compared with Methotrexate in Rheumatoid Arthritis

In an interview with HCPLive, Ryan DeMasi, MD, therapeutic area head of medical affairs, rheumatology, at AbbVie, discussed his study “Upadacitinib Monotherapy versus Methotrexate in Patients with Rheumatoid Arthritis: Efficacy and Safety Through 5 Years in the SELECT-EARLY Randomized Controlled Trial,” presented at the American College of Rheumatology’s 2023 Convergence in San Diego, California.¹

DeMasi stated in clinical practice a common challenge arises from infrequent patient visits due to the high patient volume and limited availability of rheumatology providers in the United States. Often, when patients are asked about their wellbeing during these visits, their responses may not truly reflect their overall health, as they might only recall their state from the past week and forget experiences from a month prior. To bridge this gap and offer a more accurate representation of their health between visits, it is crucial to establish a means of measuring outcomes during the interim periods. This approach enables physicians to gain a comprehensive understanding of the treatment trajectory and the patient's wellbeing, thus ensuring more effective therapy guidance based on a broader timeline, rather than relying solely on recent experiences.

Regarding treatment guidelines, the current standard involves initiating treatment with methotrexate. However, investigators developed upadacitinib for patients with rheumatoid arthritis (RA) to enhance early care. In the study, despite the patients' shorter disease duration, they exhibited severe symptoms, prompting a more aggressive early intervention approach. DeMasi explained the data presented at the meeting is significant as it shows the substantial improvements seen in the short-term are maintained over an extended period, up to 5 years. This durability of response is particularly crucial for patients dealing with a chronic, lifelong illness, emphasizing the enduring impact of the treatment over immediate effects.

Addressing the patient population with RA studied in the SELECT-EARLY study, the data provide valuable insights for physicians. Subjects had a relatively short disease duration but severe activity, which serves as a model for overall efficacy, offering a glimpse into how these therapies can impact the course of the disease in its earlier stages. Despite being an off-label indication, it serves as a representative model for overall disease control, considering the severity of symptoms and early disease intervention.

References

1. ^{van Vollenhoven R, Strand V, Takeuchi T, Chávez N, et al. Upadacitinib Monotherapy versus Methotrexate in Patients with Rheumatoid Arthritis: Efficacy and Safety Through 5 Years in the SELECT-EARLY Randomized Controlled Trial. Presented at: American College of Rheumatology Convergence 2023. San Diego, CA. November 10-15, 2023.}