Patients with rheumatoid arthritis refractory to biologics might dampen disease activity by taking the JAK inhibitor upadacitinib — but at a cost of more adverse events compared with abatacept, a trial shows.

In the SELECT-CHOICE trial, carried out in 28 countries including Australia, 612 patients with moderate to severe rheumatoid arthritis (RA) refractory to biological disease modifying antirheumatic drugs (DMARDs) were randomised to upadacatinib 15mg daily or intravenous abatacept over 24 weeks.

Infusions of abatacept, a T-cell costimulation modulator, were given at day one, weeks two, four, eight, 12, 16 and 20 at a dose of between 500mg and 1000mg depending on the patient’s weight.

The protocol in the trial, funded by upadacitinib maker Abbvie, included oral and intravenous placebos, with patients required to also be on a stable dose of a conventional synthetic DMARD.