APS: abdominal pain score; CDAI: Crohn’s Disease Activity Index; CR-100: clinical response 100; JAK: Janus kinase; QD: once daily; SES-CD: simple endoscopic activity score for Crohn’s disease; SF: stool frequency.
Study designs: the U-EXCEL and U-EXCEED induction studies were both multicenter, double-blind, placebo-controlled clinical studies. In U-EXCEL (N=526 [287 bio-naive, 239 biologic failures]) and U-EXCEED (N=495 biologic failures only), patients were randomized to RINVOQ 45 mg QD or placebo for 12 weeks with a 2:1 treatment allocation ratio and included in the efficacy analysis. In both studies, induction nonresponders were allowed to enter an additional 12-week open-label extended treatment period. All enrolled patients had moderately to severely active CD defined as SF ≥4 and/or APS ≥2, plus an SES-CD ≥6 (≥4 for patients with isolated ileal disease) excluding the narrowing component. U-ENDURE maintenance was a multicenter, double-blind, placebo-controlled clinical study with 502 patients who achieved clinical response (≥30% decrease in average daily SF and/or in APS, neither worse than baseline) to 12 weeks of RINVOQ 45 mg QD induction treatment. These patients were rerandomized 1:1:1 to receive either RINVOQ 15 mg QD, 30 mg QD, or placebo.1
Endoscopic response (co-primary endpoint): decrease in SES-CD >50% from baseline of the induction study (or for patients with an SES-CD of 4 at baseline of the induction study, at least a 2-point reduction from baseline of the induction study). Clinical remission (co-primary endpoint; SF/APS): average daily SF ≤2.8 and APS ≤1.0 and neither greater than baseline. Clinical response (CR-100): decrease of at least 100 points in CDAI from baseline. Induction steroid-free clinical remission (secondary multiplicity-controlled endpoint; SF/APS): discontinuation of steroid and achievement of clinical remission (average daily SF ≤2.8 and APS ≤1.0 and neither greater than baseline) among patients on steroids at baseline. Maintenance of steroid-free clinical remission (secondary endpoint, SF/APS): steroid-free for 90 days prior to Week 52 and achievement of clinical remission (average daily SF ≤2.8 and APS ≤1.0 and neither greater than baseline).
Please consult the Summary of Product Characteristics for further details regarding contraindications, monitoring requirements, and additional prescribing information prior to initiating RINVOQ.
Rheumatoid arthritis
RINVOQ is indicated for the treatment of moderate to severe active rheumatoid arthritis (RA) in adult patients who have responded inadequately to, or who are intolerant to one or more disease-modifying anti-rheumatic drugs (DMARDs). RINVOQ may be used as monotherapy or in combination with methotrexate.
Axial spondyloarthritis
Non-radiographic axial spondyloarthritis (nr-axSpA)
RINVOQ is indicated for the treatment of active non-radiographic axial spondyloarthritis in adult patients with objective signs of inflammation as indicated by elevated C-reactive protein (CRP) and/or magnetic resonance imaging (MRI), who have responded inadequately to nonsteroidal anti-inflammatory drugs (NSAIDs).
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REFERENCES
- RINVOQ [Summary of Product Characteristics]. AbbVie Deutschland GmbH & Co. KG; April 2023.
- Loftus EV Jr, Colombel JF, Lacerda AP, et al. Efficacy and safety of upadacitinib induction therapy in patients with moderately to severely active Crohn’s disease: results from a randomized phase 3 U-EXCEL study. Presented at: United European Gastroenterology Week; October 8-11, 2022; Vienna, Austria.