Cytokine Signalling Forum

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July 21

Upadacitinib in Patients with Psoriatic Arthritis and Inadequate Response to Biologics: 56-Week Data from the Randomized Controlled Phase 3 SELECT-PsA 2 Study

Mease PJ, Lertratanakul A, Papp KA, van den Bosch FE, Tsuji S, Dokoupilova E, Keiserman MW, Bu X, Chen L, McCaskill RM, Zueger P, McDearmon-Blondell EL, Pangan AL, Tillett W.
Rheumatol Ther. 2021;8(2):903–919

Fifty-six-week data suggest that upadacitinib could be a favourable long-term treatment option in patients with PsA who are refractory to biologic therapy. As the need for additional therapeutic agents that can effectively control disease activity continues, new data from a 56-week analysis of the oral reversible JAK1 inhibitor, upadacitinib, currently under investigation for the treatment of PsA, shows that efficacy of the drug is maintained over the duration of this study. Mease, et al. expl...

May 21

Trial of Upadacitinib and Adalimumab for Psoriatic Arthritis

McInnes IB, Anderson JK, Magrey M, Merola JF, Liu Y, Kishimoto M, Jeka S, Pacheco- Tena C, Wang X, Chen L, Zueger P, Liu J, Pangan AL, Behrens F.
N Engl J Med. 2021;384(13):1227-1239.

Upadacitinib efficacy proves to be greater than placebo, and non-inferior to adalimumab, in treating patients with psoriatic arthritis (PsA). Already approved for the treatment of rheumatoid arthritis, McInnes, et al. studied oral upadacitinib at a dose of 15 mg or 30 mg, alongside placebo or adalimumab, in this 24-week, Phase III trial, in over 1700 patients with PsA. At the primary endpoint (Week 12), ACR20 response was greater with upadacitinib than placebo, and non-inferior to adalimumab; ...

April 21

JAK selectivity and the implications for clinical inhibition of pharmacodynamic cytokine signalling by filgotinib, upadacitinib, tofacitinib and baricitinib

Traves PG, Murray B, Campigotto F, Galien R, Meng A, Di Paolo JA.
Ann Rheum Dis. 2021 Mar 19:annrheumdis-2020-219012. Epub ahead of print. DOI: 10.1136/annrheumdis-2020-219012

The first study to combine in vitro inhibition of cytokine responses in whole blood with clinical pharmacokinetics of individual JAKinibs to model daily cytokine-mediated pharmacodynamic profiles in healthy individuals and patients with RA, has demonstrated that JAKinib potencies depended on cytokine stimulus, pSTAT readout and cell type. Traves and colleagues have observed that JAKinibs have unique, differential effects on specific cytokine signalling pathways, dependent on cytokine stimulus, S...

March 21

Upadacitinib en Artritis Reumatoide: Una Evaluación de Riesgo-Beneficio en el Programa de Fase III

Conaghan PG, Mysler E, Tanaka Y, Da Silva-Tillmann B, Shaw T, Liu J, Ferguson R, Enejosa JV, Cohen S, Nash P, Rigby W, Burmester G.
Drug Saf. 2021 Feb 2. DOI: 10.1007/s40264-020-01036-w

Upadacitinib 15 mg has a favourable benefit–risk profile according to an assessment of data from the phase III SELECT clinical trial programme. In this review of data for the once-daily, oral JAK inhibitor, Conaghan PG, et al. provided insights into the benefit–risk profile of upadacitinib in approximately 4400 patients with RA. Based on pooled data from five pivotal studies, benefits and risks were assessed up to the time of regulatory submission, and additional long-term integra...

Keywords: JAK, Upadacitinib, Clinical, Phase 3

February 21

Upadacitinib Monoterapia Versus Metotrexato Monoterapia en Pacientes Japoneses con Artritis Reumatoide Metotrexato Naïve: Un subanálisis del estudio de fase 3 SELECT-EARLY

Takeuchi T, Rischmueller M, Blanco R, Xavier RM, Ueki Y, Atsumi T, Chen S, Friedman A, Pangan AL, Strand V, van Vollenhoven RF.
Mod Rheumatol 2021;26:1–16.

In this sub-analysis of the Phase 3 SELECT-EARLY study, UPA demonstrated clinical efficacy superior to placebo in the Japanese subpopulation. Along with a favourable efficacy observed with the Japan-specific 7.5 mg dose of UPA for all secondary endpoints. SELECT-EARLY was designed to study the safety and efficacy of UPA 15 and 30mg as monotherapy, but it also included a subset of 138 Japanese patients, 40% of whom were randomised to receive UPA 7.5mg. This was designed to meet the requirements...

Keywords: JAK, Upadacitinib, Clinical, Phase 3

January 21

Upadacitinib en Artritis Psoriásica Refractaria a Biológicos: SELECT-PsA 2

Mease PJ, Lertratanakul A, Anderson JK, Papp K, Van den Bosch F, Tsuji S, Dokoupilova E, Keiserman M, Wang X, Zhong S, McCaskill RM, Zueger P, Pangan AL, Tillett W.
Annals of the rheumatic diseases. 2021 Mar 1;80(3):312-20.

In this trial of patients with active PsA who had inadequate response or intolerance to at least one biologic DMARD, upadacitinib 15 mg and 30 mg was more effective than placebo over 24 weeks in improving signs and symptoms of PsA. Despite the availability of bDMARDs in PsA, only a small proportion of patients achieve the recommended target of minimal disease activity; as such, additional treatment options are needed. Upadacitinib is under evaluation for PsA. This paper reports the 24-week data...

Keywords: JAK, Upadacitinib, Clinical, Efficacy

December 20

Cambiando entre el inhibidor de Janus quinasa upadacitinib y adalimumab siguiendo respuesta insuficiente: eficacia y seguridad en pacientes con artritis reumatoide

Fleischmann RM, Blanco R, Hall S, Thomson GTD, Van den Bosch FE, Zerbini C, Bessette L, Enejosa J, Li Y, Song Y, DeMasi R, Song I-H.
Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-21841220

Both ACR and EULAR recommend adding a biologic or targeted synthetic DMARD in patients who do not achieve treatment goals at follow-up. Findings indicated that an immediate switch in mechanism of action (from JAKi to TNFi and vice versa) following treat-to-target principles is feasible with minimal risk of flare regardless of whether patients are switched due to non-response or incomplete-response. SELECT-COMPARE followed treat-to-target principles to examine the efficacy of switching in two pat...

November 20

Perfil de Seguridad de Upadacitinib en Artritis Reumatoide: Un análisis integrado de seguridad del Programa Clínico de Fase III SELECT

Cohen SB, van Vollenhoven RF, Winthrop KL, Zerbini CAF, Tanaka Y, Bessette L, Zhang Y, Khan N, Hendrickson B, Enejosa JV, Burmester GR.
Ann Rheum Dis 2020 DOI:10.1136/annrheumdis-2020-218510

This integrated Phase III safety analysis of UPA showed that UPA had a similar profile to ADA and MTX for serious infections, malignancies, and thromboembolic events. Patients receiving UPA had increased risk of HZ and creatine phosphokinase elevation versus ADA. This integrated Phase III safety analysis of UPA examined >3500 RA patients and 4000 patient-years of exposure. Data were pooled from 3834 patients in SELECT-NEXT, SELECT-BEYOND, SELECT-MONOTHERAPY, SELECT-COMPARE and SELECT-EARLY s...

Keywords: JAK, Upadacitinib, Clinical, Safety

Translated by: Igor Kos

Ensayo Clínico de Upadacitinib o Abatacept en Artritis Reumatoide

Rubbert‑Roth A, Enejosa J, Pangan AL, Haraoui B, Rischmueller M, Khan N, Zhang Y, Martin N, Xavier RM.
N Engl J Med 2020;383:1511–21 DOI: 10.1056/NEJMoa2008250

In patients with refractory RA to bDMARDs, upadacitinib was found to be superior to abatacept in DAS28-CRP change from baseline and the achievement of remission at week 12. 612 bDMARD-IR patients were randomised 1:1 to UPA 15 mg QD or ABA, each in combination with stable synthetic DMARDs. At Week 12, patients with <20% decrease in TJC and Swollen joint count (SJC) had background medication adjusted or added. All patients completing Week 24 were eligible to remain in an open-label, long-term ...

Keywords: JAK, Upadacitinib, Clinical, Efficacy

Translated by: Igor Kos

August 20

Eficacia y Seguridad de Upadacitinib Monoterapia en Pacientes Metotrexato-Naïve con Artritis Reumatoide Moderada a Grave (SELECT- EARLY): Un Ensayo Aleatorizado, Doble-ciego, con Comparador Activo Multicéntrico Internacional

van Vollenhoven R, Takeuchi T, Pangan AL, Friedman A, Mohamed MEF, Chen S, Rischmueller M, Blanco R, Xavier RM, Strand V.
Arthritis Rheumatol 2020

Upadacitinib monotherapy demonstrated superior clinical, radiographic, and patient-reported outcomes versus methotrexate in methotrexate-naïve RA patients. This 48-week double-blind active comparator study investigated upadacitinib monotherapy in patients with early RA, who were either methotrexate-naïve, or who had very limited exposure. 947 patients were randomised to once-daily upadacitinib 15 or 30 mg, or weekly methotrexate. Unusually, there were two separate primary endpoints, s...

Keywords: JAK, Upadacitinib, Efficacy

Translated by: Igor Koz

April 20

Eficacia y Seguridad Relativas de Tofacitinib, Baricitinib, Upadacitinib y Filgotinib en Comparación con Adalimumab en pacientes con Artritis Reumatoide Activa

Lee YH, Song GG.
Z Rheumatol. 2020 DOI: 10.1007/s00393-020-00750-1

This Bayesian network meta-analysis, comparing the relative efficacy and safety of JAK inhibitors, determined BARI 4mg + MTX and UPA 15mg + MTX were the most effective. The analysis included 5451 patients with an inadequate response to MTX and active RA, from four RCTs. Relative effects were converted into a probability allowing each treatment to be ranked. BARI and UPA had significantly higher ACR20 response rates than ADA 40mg + MTX whilst TOF 5mg and FIL 200mg had comparable ACR20 response ...

Keywords: JAK, Baricitinib

Translated by: Igor Koz

February 20

Inhibición Preferencial de JAK1 en Relación a JAK 3 por Upadacitinib: Análisis de la Exposición-Respuesta de Datos Ex Vivo en 2 Ensayos Clínicos Fase 1 y Comparación con Tofacitinib

Mohamed MF, Beck D, Camp HS, Othman AA.
Pharmacodynamics. 2020

Ex vivo pharmacodynamic assay results demonstrated a greater selectivity of UPA on JAK1 versus JAK3 compared to TOF. This analysis conducted ex vivo stimulation of STAT3 phosphorylation by IL-6 as a measure of JAK1 activity and STAT5 phosphorylation by IL-7 as a measure of JAK1/JAK3 activity. Change in pSTAT3 and pSTAT5 were calculated at 1, 6 and 12 hours following drug administration using samples collected from healthy subjects and subjects with RA, from 2 phase 1 studies. Exposure-response...

Keywords: JAK, Upadacitinib, Preclinical, MOA

Translated by: Igor Kos

January 20

Efectos de Upadacitinib en los Resultados Reportados por los Pacientes: Resultados de SELECT-BEYOND, un Estudio clínico Aleatorizado de Fase 3 en Pacientes con Artritis Reumatoide y Respuesta Inadecuada a los Fármacos Antirreumáticos Modificadores de la Enfermedad

Strand V, Schiff M, Tunida N, Friedman A, Meerwein S, Pangan A, Ganguli A, Fuldeore M, Song Y, Pope J.
Arthritis Res Ther . 2019 Dec 2;21(1):263. doi: 10.1186/s13075-019-2059-8.

In SELECT-BEYOND, UPA demonstrated clinically meaningful improvements in patient reported outcomes compared to PBO in patients with RA who had an inadequate response to bDMARDs. In this post-hoc analysis of the SELECT-BEYOND study, the effect of UPA 15 or 30 mg on patient reported outcomes were assessed and compared to PBO. Eligible patients (498) with an inadequate response to bDMARDs were randomly assigned 1:1:1 to receive UPA 15 mg, UPA 30 mg or PBO. PROs collected at Wk1, Wk4, and Wk12 inclu...

Keywords: JAK, Upadacitinib, Clinical, PRO

Translated by: Igor Koz

Upadacitinib Mejora los Resultados Reportados por los Pacientes en Pacientes con Artritis Reumatoide y Respuesta Inadecuada a Fármacos Antirreumáticos Modificadores de la Enfermedad Sintéticos Convencionales: Resultados de SELECT-NEXT

Strand V, Pope J, Tundia N, Friedman A, Camp H, Pangan A, Ganguli A, Fuldeore M, Goldschmidt D, Schiff M.
Arthritis Res Ther . 2019 Dec 9;21(1):272.

In SELECT-NEXT, UPA demonstrated clinically meaningful improvements in patient reported outcomes compared to PBO in patients with RA who had an inadequate response to csDMARDs. In this post hoc analysis, the effect of UPA 15 or 30 mg on patient reported outcomes were assessed and compared to PBO. Eligible patients (661) with an inadequate response to csDMARDs were randomly assigned 2:2:1:1 to receive background csDMARD therapy with either UPA 15 mg, UPA 30 mg or PBO. PROs collected at Wk4 and Wk...

Keywords: JAK, Upadacitinib, Clinical, PRO

Translated by: Igor Koz

November 19

Análisis de Exposición Respuesta de Eficacia y Seguridad de Upadacitinib en Estudios de Fase 2 y 3 para Apoyar la Evaluación de Riesgo Beneficio en la Artritis Reumatoide

Nader A, Mohamed M-EF, Winzenborg I, Doelger E, Noertersheuser P, Pangan AL, Othman AA.
Clin Pharmacol Ther . 2020 Apr;107(4):994-1003. doi: 10.1002/cpt.1671.

UPA 15 mg provided the optimal benefit-risk in RA through maximizing efficacy with only small incremental benefit with 30 mg, and with consistency across RA subpopulations and with UPA monotherapy or combination with csDMARDs. Exposure-response analyses were conducted using combined data from two Phase 2b and five Phase 3 studies in order to characterise the relationship between plasma exposure and efficacy, as well as to select safety parameters using the totality of the data in subjects with...

Keywords: JAK, Upadacitinib, Clinical, Efficacy

Translated by: Igor Kos

September 19

Comparación de la Regulación de la Señalización de Citoquinas Mediada por Baricitinib, Upadactinib y Tofacitinib en Subpoblaciones de Leucocitos Humanos

McInnes IB, Byers NL, Higgs RE, Lee J, Macias WL, Na S, Ortmann RA, Rocha G, Rooney TP, Wehrman T, Zhang X, Zuckerman SH, Taylor PC.
Arthritis Res Ther. 2019 Aug 2;21(1):183

Different JAKinibs modulated distinct cytokine pathways to varying degrees, and no agent potently or continuously inhibited an individual cytokine signalling pathway throughout the dosing interval. This study aimed to compare the in vitro cellular pharmacology of BARI, TOF and UPA across relevant leukocyte subpopulations, coupled with their in vivo PK, to determine their effects on distinct cytokine pathways. Peripheral blood mononuclear cells from healthy donors were incubated with differen...

Keywords: JAK, Upadacitinib, Preclinical, Selectivity

Translated by: Igor Koz

August 19

Upadacitinib versus Placebo o Adalimumab en Pacientes con Artritis Reumatoide y una Respuesta inadecuada a Metotrexate: Resultados de un Estudio de Fase 3, aleatorizado, controlado doble ciego

Fleischmann R, Pangan AL, Song IH, Mysler E, Bessette L, Peterfy C, Durez P, Ostor AJ, Li Y, Zhou Y, Othman AA, Genovese MC.
Arthritis Rheumatol 2019 DOI: 10.1002/art.41032

UPA demonstrated superiority to ADA in terms of clinical, functional and patient-reported outcomes with comparable radiographic inhibition. As many RA patients fail to achieve LDA and remission with TNF inhibitors and MTX there is a requirement for additional treatment options. In this SELECT-COMPARE study the clinical and functional outcomes of UPA were compared to ADA in MTX-IR patients. 1629 MTX-IR were randomly assigned 2:2:1 to; UPA 15mg QD, ADA 40mg Q2W or PBO, with background MTX. Key e...

Keywords: JAK, Upadacitinib, Clinical, Efficacy

Seguridad y Efectividad de Upadacitinib o Adalimumab más Metotrexate en Pacientes con Artritis Reumatoide: Más de 48 Semanas de Troca para una Terapia Alternativa con Respuesta Insuficiente

Fleischmann RM, Genovese MC,  Enejosa JV,  Mysler E, Bessette L, Peterfy C,  Ostor P,  Li Y,  Song I.
Ann Rheum Dis 2019 DOI: 10.1136/annrheumdis-2019-215764

Consistent with Wk26 data, significantly more UPA patients achieved LDA and remission versus ADA and PBO over 48 weeks. RA patients often change therapy due to inadequate response and intolerance. The SELECT COMPARE study was designed to explore switching to JAK inhibitors from TNF inhibitors without a wash-out period (and vice versa). The long-term safety and efficacy of UPA was compared to ADA and PBO in MTX-IR. 1629 patients were blindly assigned 2:2:1 to; UPA 15mg QD, ADA 40mg Q2W and PBO, ...

Keywords: JAK, Upadacitinib, Clinical, Efficacy

June 19

Upadacitinib as Monotherapy in Patients with Active Rheumatoid Arthritis and Inadequate Response to Methotrexate (SELECT-MONOTHERAPY): A Randomised, Placebo-Controlled, Double-Blind Phase 3 Study

Smolen JS, Pangan AL, Emery P, Rigby W, Tanaka Y, Vargas JI, Zhang Y, Damjanov N, Friedman A, Othman AA, Camp HS, Cohen S.
Lancet. 2019 Jun 8;393(10188):2303-2311

UPA monotherapy showed statistically significant improvements in clinical and functional outcomes versus continuing MTX in MTX inadequate-responder patients with RA. Despite its proven effectiveness and safety, many patients are unable to tolerate MTX due to its side-effects. Therapies that can be used without concomitant MTX therefore, have an important place in RA management. In previous studies, UPA has shown efficacy in combination with stable background csDMARDs in RA patients who are DMA...

July 18

Seguridad y Eficacia de Upadacitinib en Pacientes con Artritis Reumatoide Activa Refractaria a Fármacos Anti-Reumaticos Modificadores de la Enfermedad Biológicos (SELECT-BEYOND) un Ensayo Aleatorizado Controlado Fase 3

Genovese MC, Fleischmann R, Combe B, Hall S, Rubbert-Roth A, Zhang Y, Zhou Y, Mohamed M-EF, Meerwein S, Pangan AL.
Lancet 2018;391:2513–24

Upadacitinib (UPA) extended release formulation was effective in treating patients with moderate-to-severe RA with an inadequate response to bDMARDs. Phase 2 study data has shown that UPA is an efficacious and safe treatment for active RA.1,2 SELECT-BEYOND was a double-blind, long-term extension, Phase 3 study to assess the efficacy of UPA in patients with RA who were bDMARD-IR. The first 12-weeks of SELECT-BEYOND were placebo-controlled, with a double-blind period followed by an ongoing double...

Keywords: JAK, Upadacitinib, Clinical, Phase 3

Translated by: Igor Kos

Seguridad y Eficacia de Upadacitinib en pacientes con Artritis Reumatoide con Respuesta Inadecuada a Fármacos Anti-Reumáticos Modificadores de la Enfermedad (SELECT-NEXT): un Ensayo Aleatorizado, Doble Ciego, Controlado-Placebo Fase 3

Burmester GR, Kremer JM, Van den Bosch F, Kivitz A, Bessette L, Li Y, Zhou Y, Othman AA, Pangan AL, Camp HS.
Lancet 2018;391:2503–12

Patients with moderate-to-severe active RA had significant improvements in clinical signs and symptoms with upadacitinib (UPA) compared with placebo. In Phase 2 studies, UPA showed favourable efficacy when administered twice daily as an immediate-release formulation at doses of 6–12 mg in patients with active RA who had TNFi-IR.1,2 An extended-release formulation allowing once-daily (QD) administration was developed for Phase 3 studies. SELECT-NEXT was a double-blind, multicentre, Phase 3...

Keywords: JAK, Upadacitinib, Clinical, Phase 3

Translated by: Igor Kos

May 18

Farmacocinética de Upadacitinib con Regímenes Clínicos de Formulación de Liberación Extendida Utilizados en Ensayos Clínicos Fase 3 de Artritis Reumatoide

Mohamed MEF, Zeng J, Marroum PJ, Song IH, Othman AA.
Clin Pharmacol Drug Dev. 2019 Feb;8(2):208-216. doi: 10.1002/cpdd.462

Upadacitinib (UPA) extended release (ER) formulation dosing achieved the target profile that enables single dosing in patients with RA. In early clinical studies, UPA was given as an immediate release (IR) formulation, however patients were noted to experience fluctuations in blood plasma concentrations. To enhance patient compliance in UPA Phase 3 trials, ER tablets have been developed. Here, authors aimed at characterising the pharmacokinetics of UPA single and multiple doses of ER compared ...

Keywords: JAK, Upadacitinib, Preclinical, PK-PD

December 17

Inhibición de JAK como una estrategia terapéutica para Enfermedades Inmunes e Inflamatorias

Schwartz DM, Kanno Y, Villarino A, Ward M, Gadina M, O’Shea JJ.
Nat Rev Drug Discov 2017;16:843–62 DOI: 10.1038/nrd.2017.201

Janus kinases (JAKs) are essential mediators of downstream signaling pathways in many inflammatory and autoimmune diseases. This review summarizes current clinical data on first- and second-generation JAK inhibitors (jakinibs) and discusses their use for the treatment of immune and inflammatory conditions. First generation jakinibs such as tofacitinib, baricitinib, and ruxolitinib, non-selectively inhibit JAK-dependent pro-inflammatory cytokines, which are major contributors to immunopathology. ...

Keywords: JAK, Tofacitinib, Clinical, Efficacy

Translated by: Igor Kos