Upadacitinib vs adalimumab in patients with rheumatoid arthritis and a prior inadequate response or intolerance to a tumour necrosis factor inhibitor: 12-week results from the randomised, double-blind, SELECT-SWITCH study
Primary result · DAS28-CRP ≤3.2 responseResult — go to the resultDifference 21.0% 95% CI 12.9–29.1Authors' conclusion
The primary endpoint of the SELECT-SWITCH trial was met, with a higher percentage of patients with active RA who switched to upadacitinib after first TNFi failure achieving DAS28-CRP ≤3.2 at 12 weeks than those cycling to a second TNFi, adalimumab, with generally similar safety profiles.
Study context
- Population
- Patients with active rheumatoid arthritis (RA) and inadequate response or intolerance to 1 nonadalimumab tumour necrosis factor inhibitor (TNFi) receiving stable MTXrandomised
- Participants
- 492 patients
- Comparison
- Upadacitinib 15 mg once daily vs adalimumab 40 mg every other week, after first TNFi failure
- Primary endpoint
- Superiority in DAS28-CRP ≤3.2
- Follow-up
- Week 12
Methodological detailsdouble-blind, 1:1 randomisation, ongoing trial
- Double-blind
- 1:1 randomisation
- Ongoing trial
Primary result
DAS28-CRP ≤3.2 response
Difference
21.0%
95% CI 12.9–29.1
P < 0.0001
By group
Upadacitinibvs Adalimumab
difference 21.0% (95% CI 12.9–29.1); P < 0.0001
As reported in the abstract
Secondary outcomes
ACR50 (ranked secondary 1) · week 12
P = 0.0068
DAS28-CRP <2.6 (ranked secondary 2) · week 12
P = 0.0002
Mean
| Outcome | Upadacitinib | Adalimumab | P value |
|---|---|---|---|
| Change from baseline in DAS28-CRP (ranked secondary 3) · week 12 | −2.432 | −1.840 | P < 0.0001 |
| Change from baseline in pain (ranked secondary 4) · week 12 | −3.165 | −2.373 | P = 0.0005 |
| Change from baseline in HAQ-DI (ranked secondary 5) · week 12Not superior | −0.523 | −0.496 | P = 0.5849 |
Safety
- Safety was comparable between treatments
Original publication
Upadacitinib vs adalimumab in patients with rheumatoid arthritis and a prior inadequate response or intolerance to a tumour necrosis factor inhibitor: 12-week results from the randomised, double-blind, SELECT-SWITCH study. Ann Rheum Dis. Published 15 April 2026. doi:10.
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