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Label indication RINVOQ/RINVOQ LQ is a Janus kinase (JAK) inhibitor. RINVOQ is indicated for the treatment of adults with moderately to severely active rheumatoid arthritis who have had an inadequate response or intolerance to one or more TNF blockers. FDA label
Also known as Upadacitinib, RINVOQ, RINVOQ LQ, C25-267
ABT-494 · 52 trials · 30 indications
The primary objective of this study is to evaluate whether treatment success in ASUC patients in patients treated with strategy U is non-inferior to strategy C after 16 weeks of initiating therapeutic management.
The SALT is a global AA severity score based on the combination of extent and density of scalp hair loss. The score is determined by visually defining the amount of terminal hair loss in each of the 4 views of the scalp (left and right side each accounting for 18% of scalp area, the top for 40%, and the back for 24%) and adding these together with a maximum score of 100%.
An AE is defined as any untoward medical occurrence in a patient or clinical investigation in which a participant is administered a pharmaceutical product which does not necessarily have a causal relationship with this treatment.
The SALT is a global alopecia areata (AA) severity score based on the combination of extent and density of scalp hair loss. The score is determined by visually defining the amount of terminal hair loss in each of the 4 views of the scalp (left and right side each accounting for 18% of scalp area, the top for 40%, and the back for 24%) and adding these together with a maximum score of 100%. A SALT score of \<= 10 is defined as less than or equal to 10% hair loss.
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], An EASI 75 response is defined as a 75% reduction (improvement) from Baseline in EASI score.
An adverse event (AE) is defined as any untoward medical occurrence in a patient or clinical investigation participant administered a pharmaceutical product and which does not necessarily have a causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal (investigational) product, whether or not the event is considered causally related to the use of the product.
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.
The vIGA-AD is a validated assessment instrument to rate the severity of atopic dermatitis globally, based on the following scale: * 0 - Clear: No inflammatory signs of AD; * 1 - Almost clear: Barely perceptible erythema, induration/papulation and/or lichenification; * 2 - Mild: Slight but definite erythema, induration/papulation and/or minimal lichenification. No oozing or crusting; * 3 - Moderate: Clearly perceptible erythema, induration/papulation and/or lichenification, oozing or crusting may be present; * 4 - Severe: Marked erythema, induration/papulation and/or lichenification; Oozing or crusting may be present.
PCDAI is an index used to measure disease activity of pediatric patients with Crohn's disease assessing abdominal pain, stool frequency, patient functioning, hematocrit, erythrocyte sedimentation rate, albumin, weight, height, abdomen, perirectal disease, and extraintestinal manifestations. It ranges from 0 to 100; higher scores indicate more active disease. Clinical remission was defined as PCDAI ≤ 10.
Endoscopic response is defined as \> 50% reduction in Simple Endoscopic Score for Crohn's Disease (SES-CD) score from Baseline (or for participants with a Baseline SES-CD of 4, at least a 2-point reduction from Baseline), as scored by a central reader.
The EASI is a validated measure used to assess the severity and extent of AD. Four AD disease characteristics (erythema, thickness \[induration, papulation, edema\], scratching \[excoriation\], and lichenification) are each assessed for severity by the investigator on a scale of "0" (absent) through "3" (severe). In addition, the area of AD involvement is assessed as a percentage by body area of head, trunk (including the genital area), upper extremities, and lower extremities (including the buttocks), and converted to a score of 0 to 6. In each body region, the area is expressed as 0, 1 (1% to 9%), 2 (10% to 29%), 3 (30% to 49%), 4 (50% to 69%), 5 (70% to 89%), or 6 (90% to 100%). The EASI score ranges from 0-72 points with an MCID of 6.6 points.
The vitiligo area scoring index (VASI) is a validated scoring method used to assess the areas of depigmentation due to vitiligo. It is based on a composite estimate of the overall area of vitiligo patches, measured by the number of hand units (palm plus 5 digits = 1% body surface area \[BSA\]) multiplied by the degree of depigmentation within each affected area (0%, 10%, 25%, 50%, 75%, 90%, or 100%). The T-VASI is calculated using a formula that includes contributions from all body regions, with a possible range from 0 to 100.
The vitiligo area scoring index (VASI) is a validated scoring method used to assess the areas of depigmentation due to vitiligo. The F-VASI includes contributions from the face, with a possible range from 0 to 3.
The vitiligo area scoring index (VASI) is a validated scoring method used to assess the areas of depigmentation due to vitiligo. It is based on a composite estimate of the overall area of vitiligo patches, measured by the number of hand units (palm plus 5 digits = 1% body surface area \[BSA\]) multiplied by the degree of depigmentation within each affected area (0%, 10%, 25%, 50%, 75%, 90%, or 100%). The T-VASI is calculated using a formula that includes contributions from all body regions, with a possible range from 0 to 100.
The Mayo score is a tool designed to measure disease activity for ulcerative colitis. The AMS is a composite of the following subscores: stool frequency subscore (SFS), rectal bleeding subscore (RBS) and endoscopy subscore (MES). AMS ranges from 0 to 9 where higher scores represent more severe disease. Clinical remission is defined as an AMS \< or = 2, with SFS \< or = 1 and not higher than baseline, RBS of 0, and MES \< or = 1.
The Mayo score is a tool designed to measure disease activity for ulcerative colitis. AMS ranges from 0 to 9 where higher scores represent more severe disease. Clinical remission is defined as an AMS ≤ 2, with SFS ≤ 1 and not higher than Baseline, RBS of 0, and MES ≤ 1.
The SALT is a global AA severity score based on the combination of extent and density of scalp hair loss. The score is determined by visually defining the amount of terminal hair loss in each of the 4 views of the scalp (left and right side each accounting for 18% of scalp area, the top for 40%, and the back for 24%) and adding these together with a maximum score of 100%.
ACR criteria measure improvements in tender and swollen joint counts, patient assessments of pain, global disease activity and physical function, physician global assessment of disease activity and acute phase reactant. ACR 30 Response is defined as absence of fever \[\> 38°C\] in the previous 1 week preceding evaluation and improvement of ≥ 30% of the 6 variables of the JIA core set with no more than 1 variable worsening by \> 30%.
BICLA is a composite responder index based on improvement in organ systems without worsening of the overall condition and improvement in disease activity.
HiSCR 50 is defined as at least a 50% reduction in the total abscess and inflammatory nodule (AN) count with no increase in abscess count and no increase in draining fistula count relative to Baseline.
The DAS28-CRP is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (NRS), and high-sensitivity C-reactive protein (hsCRP; in mg/L). Scores on the DAS28-CRP range from 0 to approximately 10, where higher scores indicate more disease activity. Low Disease Activity (LDA) based on DAS28 (CRP) is defined as achieving a DAS28 (CRP) of less than or equal to 3.2.
The EASI is a composite index with scores ranging from 0 to 72. Four AD disease characteristics (erythema, thickness \[induration, papulation, edema\], scratching \[excoriation\], and lichenification) assessed for severity on a scale of "0" (absent) through "3" (severe). In addition, the area of AD involvement is assessed as a percentage by body area of head, trunk (including the genital area), upper extremities, and lower extremities (including the buttocks), and converted to a score of 0 to 6. In each body region, the area is expressed as 0, 1 (1% to 9%), 2 (10% to 29%), 3 (30% to 49%), 4 (50% to 69%), 5 (70% to 89%), or 6 (90% to 100%). The Worst Pruritus NRS is an assessment tool that participants used to report the intensity of their pruritus during a 24-hour recall period using an electronic hand-held device. Participants rated itch (pruritus) intensity at its worst during the past 24 hours on an 11-point scale from 0 (no itch) to 10 (worst imaginable itch).
Relapse of TAK is defined as the presence of signs or symptoms as judged by the investigator for at least 2 of the following categories: objective systemic symptoms, subjective systemic symptoms, elevated inflammation markers, vascular signs and symptoms, or ischemic symptoms OR where the criteria are met based on one category per protocol definition of relapse of TAK.
Treatment-emergent adverse events (TEAEs) are defined as any adverse events that begin or worsen in severity after initiation of upadacitinib during Lead-In Study M16-046 for the UPA/UPA arm or this Study M19-850 DUPI/UPA arm through 30 days following the last dose of upadacitinib.
Treatment-emergent adverse events were monitored throughout the study to identify any adverse events of special interest that may indicate a trend or risk to participants. AESIs are defined as any adverse events that begin or worsen in severity after initiation of upadacitinib during Study M16-046 for the UPA/UPA arm or Study M19-850 for the DUPI/UPA arm through 30 days following the last dose of upadacitinib.
Clinical laboratory test values are considered PCI if they meet either the lower-limit or higher-limit PCI criteria defined in the categories below. Percentage of participants with PCI laboratory values are summarized for hematology and chemistry. The Number Analyzed is defined as the number of participants with at least one post-baseline value for the specific criteria. Post-baseline grade must also be more extreme (worse) than the baseline grade in order to be included in the count. If a participant does not have a baseline value then the participant would be counted in the numerator if the participant had at least one post-baseline. xULN = Times upper limit of the normal range.
PCI post-baseline vital sign values are summarized for categories: systolic and diastolic blood pressures \[sitting\], pulse rate \[sitting\], and weight. Only those categories where at least 1 person had a non-PCI value at Baseline and met the PCI criterion at least once during post-baseline are reported. The Number Analyzed is defined as the number of participants with at least one post-baseline value for the specific criteria. Post-baseline grade must also be more extreme (worse) than the baseline grade in order to be included in the count. If a participant does not have a baseline value then the participant would be counted in the numerator if the participant had at least one post-baseline.
ASAS40 response was defined as improvement of ≥ 40% relative to Baseline and absolute improvement of ≥ 2 units (on a scale from 0 to 10) in ≥ 3 of the following 4 domains with no deterioration (defined as a net worsening of \> 0 units) in the potential remaining domain: * Patient's global assessment of disease activity, measured on a numeric rating scale (NRS) from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related Bath AS Disease Activity Index (BASDAI) NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).
ASAS40 response was defined as improvement of ≥ 40% relative to Baseline and absolute improvement of ≥ 2 units (on a scale from 0 to 10) in ≥ 3 of the following 4 domains with no deterioration (defined as a net worsening of \> 0 units) in the potential remaining domain: * Patient's global assessment of disease activity, measured on a numeric rating scale (NRS) from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related Bath AS Disease Activity Index (BASDAI) NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.
Sustained remission is defined as having achieved absence of giant cell arteritis (GCA) signs and symptoms from Week 12 through Week 52, and adherence to the protocol-defined corticosteroid (CS) taper regimen.
The Adapted Mayo Score is a composite score of UC disease activity based on the following 3 subscores: 1. Stool frequency subscore (SFS), scored from 0 (normal number of stools) to 3 (5 or more stools more than normal). 2. Rectal bleeding subscore (RBS), scored from 0 (no blood seen) to 3 (blood alone passed). 3. Endoscopic subscore, scored from 0 (normal or inactive disease) to 3 (severe disease, spontaneous bleeding, ulceration). The overall Adapted Mayo score ranges from 0 to 9 where higher scores represent more severe disease. Clinical remission is defined as an Adapted Mayo score ≤ 2, with SFS ≤ 1 and not higher than Baseline, RBS of 0, and endoscopic subscore ≤ 1.
Adverse events are defined as those that began or worsened in severity after the first dose of study drug but within 30 days after the last dose of study drug.
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for redness (erythema, inflammation), thickness (induration, papulation, swelling - acute eczema), scratching (excoriation), and lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease.
The vIGA-AD is a validated assessment instrument to rate the severity of atopic dermatitis globally, based on the following scale: * 0 - Clear: No inflammatory signs of AD; * 1 - Almost clear: Barely perceptible erythema, induration/papulation and/or lichenification; * 2 - Mild: Slight but definite erythema, induration/papulation and/or minimal lichenification. No oozing or crusting; * 3 - Moderate: Clearly perceptible erythema, induration/papulation and/or lichenification, oozing or crusting may be present; * 4 - Severe: Marked erythema, induration/papulation and/or lichenification; Oozing or crusting may be present.
Clinical remission per CDAI is defined as CDAI \<150.
Endoscopic response is defined as decrease in Simple Endoscopic Score for Crohn's Disease (SES-CD) from Baseline.
Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR20 response criteria: 1. ≥ 20% improvement in 68-tender joint count; 2. ≥ 20% improvement in 66-swollen joint count; and 3. ≥ 20% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
The co-primary endpoint for United States (US)/Food and Drug Administration (FDA) regulatory purposes was clinical remission based on CDAI at Week 12. CDAI is a composite instrument that includes participant symptoms evaluated over 7 days (abdominal pain, stool frequency and general well-being), as well as presence of complications (arthritis/arthralgia, iritis/uveitis, erythema nodosum/pyoderma gangrenosum/aphthous stomatitis, anal fissure/fistula/abscess, other fistula, and fever), the use of antidiarrheal medicines, presence of an abdominal mass, hematocrit, and body weight. These items are scored individually, weighted, and do not contribute equally to the overall score. The CDAI is derived from summing up the weighted individual scores of eight items. CDAI approximately ranges from 0 to 600 with higher scores indicating more severe disease. Clinical remission is defined as a CDAI score less than 150.
The co-primary endpoint for European Union (EU)/European Medicines Agency (EMA) regulatory purposes was clinical remission defined based on two patient reported outcomes, average daily stool frequency (SF) and average daily abdominal pain score (APS). Clinical remission per PROs was defined as average daily very soft or liquid SF ≤ 2.8 and average daily APS ≤ 1.0 and neither worse than Baseline. Participants recorded APS and the number of very soft or liquid SF daily in an electronic diary. Abdominal pain was rated on a scale from 0 (none) to 3 (severe). The average daily very soft or liquid SF and APS were calculated using the 4-7 most recent useable days of patient-report outcomes (i.e., excluding days with missing entries or associated with endoscopy procedures) out of the last 14 days prior to the Week 12 visit.
Endoscopic response at Week 12 was a co-primary endpoint for both the US/FDA and EU/EMA regulatory purposes. Endoscopic response was defined as greater than 50% decrease in Simple Endoscopic Score for Crohn's Disease (SES-CD) from Baseline of the induction study (or for participants with an SES-CD of 4 at Baseline, at least a 2-point reduction from Baseline), as scored by independent external and blinded central readers. The SES-CD evaluates 4 endoscopic variables (ulcer size, ulcerated surface, affected surface, and narrowing, each on a scale from 0 (none) to 3 in 5 segments assessed during ileocolonoscopy (ileum, right colon, transverse colon, sigmoid and left colon, and rectum). The total score is the sum of the 4 endoscopic variable scores and ranges from 0 to 56, where higher scores indicate more severe disease.
The Disease Activity Score (DAS) 28 is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (0-100 mm), and high-sensitivity C-reactive protein (hsCRP; in mg/L). Scores on the DAS28 range from 0 to approximately 10, where higher scores indicate more disease activity. A negative change from Baseline indicates improvement in disease activity.
Treatment-emergent adverse events are defined as events that begin or worsen either on or after the first dose of the study drug and within 30 days after the last dose of the study drug in the analysis period.
The primary endpoint for United States (US)/Food and Drug Administration (FDA) regulatory purposes was ACR 20% response (ACR20) at Week 14. Participants who met the following 3 conditions for improvement from baseline were classified as meeting the ACR20 response criteria: 1. ≥ 20% improvement in 68-tender joint count; 2. ≥ 20% improvement in 66-swollen joint count; and 3. ≥ 20% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
The primary endpoint for European Union (EU)/European Medicines Agency (EMA) regulatory purposes was low disease activity, based on a Disease Activity Score 28 (DAS28)-CRP score of ≤ 3.2 at Week 14. The DAS28 is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (0-100 mm), and hsCRP (in mg/L). Scores on the DAS28 range from 0 to approximately 10, where higher scores indicate more disease activity. A DAS28 score less than or equal to 3.2 indicates low disease activity.
The primary endpoint for European Union (EU)/European Medicines Agency (EMA) regulatory purposes was low disease activity, based on a Disease Activity Score 28 (DAS28)-CRP score of ≤ 3.2 at Week 12. The DAS28 is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (0-100 mm), and hsCRP (in mg/L). Scores on the DAS28 range from 0 to approximately 10, where higher scores indicate more disease activity. A DAS28 score less than or equal to 3.2 indicates low disease activity.
The primary endpoint for United States (US)/Food and Drug Administration (FDA) regulatory purposes was ACR 50% response (ACR50) at Week 12. Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR50 response criteria: 1. ≥ 50% improvement in 68-tender joint count; 2. ≥ 50% improvement in 66-swollen joint count; and 3. ≥ 50% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
The primary endpoint for European Union (EU)/European Medicines Agency (EMA) regulatory purposes was clinical remission, based on a Disease Activity Score 28 (DAS28)-CRP score of \< 2.6 at Week 24. The DAS28 is a composite index used to assess rheumatoid arthritis disease activity, calculated based on the tender joint count (out of 28 evaluated joints), swollen joint count (out of 28 evaluated joints), Patient's Global Assessment of Disease Activity (0-100 mm), and hsCRP (in mg/L). Scores on the DAS28 range from 0 to approximately 10, where higher scores indicate more disease activity. A DAS28 score less than 2.6 indicates clinical remission.
The primary endpoint for Japan/Pharmaceuticals and Medical Devices Agency (PMDA) regulatory purposes was ACR 20% response (ACR20) at Week 12. Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR20 response criteria: 1. ≥ 20% improvement in 68-tender joint count; 2. ≥ 20% improvement in 66-swollen joint count; and 3. ≥ 20% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
The second primary endpoint for Japan/PMDA regulatory purposes was change from baseline in mTSS at Week 24. The mTSS measures the level of joint damage from radiographs of the hands and feet. Joint erosion and joint space narrowing (JSN) were assessed by two independent, blinded readers. Joint erosion was assessed in 16 joints in each hand/wrist and 6 joints in each foot. Each joint was scored from 0 (no erosion) to 5 for hands/wrists or to 10 for feet (complete collapse). The total erosion score ranges from 0 to 280 (worst). JSN was assessed in 15 joints of each hand and wrist, and 6 joints of each foot, including subluxation, from 0 (normal) to 4 (complete loss of joint space, bony ankylosis, or luxation). The total JSN score ranges from 0 to 168 (worst). The mTSS is the sum of the joint erosion and JSN scores and ranges from 0 (normal) to 448 (worst). A change from Baseline greater than 0 indicates progression.
Peak eosinophil count (number of eosinophils per high power field (eos/hpf)) will be measured at 12-weeks post-treatment via esophageal biopsy during the study endoscopy. Eosinophil counts will be determined centrally by the study pathologist using a validated protocol.
The vitiligo area scoring index (VASI) is a validated scoring method used to assess the areas of depigmentation due to vitiligo. The F-VASI includes contributions from the face, with a possible range from 0 to 3, with higher scores indicating more severe disease. Negative changes from baseline indicate improvement.
HiSCR is defined as at least a 50% reduction in the total abscess and inflammatory nodule (AN) count with no increase in abscess count and no increase in draining fistula count relative to Baseline.
ASAS 40 response was defined as improvement of ≥ 40% relative to Baseline and absolute improvement of ≥ 2 units (on a scale from 0 to 10) in ≥ 3 of the following 4 domains with no deterioration (defined as a net worsening of \> 0 units) in the potential remaining domain: * Patient's global assessment of disease activity, measured on a numeric rating scale (NRS) from 0 (no activity) to 10 (severe activity); * Pain, measured by the total back pain NRS from 0 (no pain) to 10 (most severe pain); * Function, measured by the Bath Ankylosing Spondylitis Functional Index (BASFI) which consists of 10 items assessing participants' ability to perform activities on an NRS ranging from 0 (easy) to 10 (impossible); * Inflammation, measured by the mean of the 2 morning stiffness-related Bath AS Disease Activity Index (BASDAI) NRS scores (items 5 \[level of stiffness\] and 6 \[duration of stiffness\]) each on a scale from 0 (none/0 hours) to 10 (very severe/2 hours or more duration).
EASI is a tool used to measure the extent (area) and severity of atopic eczema based on assessments of the head/neck, trunk, upper limbs and lower limbs. For each region the area score is recorded as the percentage of skin affected by eczema. For each region, the severity score is calculated as the sum of the intensity scores (scored as none \[0\], mild \[1\], moderate \[2\], or severe \[3\]) for Redness (erythema, inflammation), Thickness (induration, papulation, swelling - acute eczema), Scratching (excoriation), and Lichenification (lined skin, prurigo nodules - chronic eczema). The total EASI score for each region is calculated by multiplying the severity score by the area score, with adjustment for the proportion of the body region to the whole body. The final EASI score is the sum of the 4 region scores and ranges from 0 to 72 where higher scores represent worse disease; a negative change from baseline indicates improvement.
The Adapted Mayo Score is a composite score of UC disease activity based on the following 3 subscores: 1. Stool frequency subscore (SFS), scored from 0 (normal number of stools) to 3 (5 or more stools more than normal) 2. Rectal bleeding subscore (RBS), scored from 0 (no blood seen) to 3 (blood alone passed) 3. Endoscopic subscore, scored from 0 (normal or inactive disease) to 3 (severe disease, spontaneous bleeding, ulceration) The overall Adapted Mayo score ranges from 0 to 9 where higher scores represent more severe disease. For Substudy 1, clinical remission is defined as SFS ≤ 1, RBS of 0, and endoscopic subscore ≤ 1.
The Adapted Mayo Score is a composite score of UC disease activity based on the following 3 subscores: 1. Stool frequency subscore (SFS), scored from 0 (normal number of stools) to 3 (5 or more stools more than normal) 2. Rectal bleeding subscore (RBS), scored from 0 (no blood seen) to 3 (blood alone passed) 3. Endoscopic subscore, scored from 0 (normal or inactive disease) to 3 (severe disease, spontaneous bleeding, ulceration) The overall Adapted Mayo score ranges from 0 to 9 where higher scores represent more severe disease. For Substudy 2, clinical remission is defined as SFS ≤ 1 and not greater than Baseline, RBS of 0, and endoscopic subscore ≤ 1. In Substudy 2, evidence of friability during endoscopy in participants with otherwise "mild" endoscopic activity conferred an endoscopic subscore of 2.
The Adapted Mayo Score is a composite score of UC disease activity based on the following 3 subscores: 1. Stool frequency subscore (SFS), scored from 0 (normal number of stools) to 3 (5 or more stools more than normal). 2. Rectal bleeding subscore (RBS), scored from 0 (no blood seen) to 3 (blood alone passed). 3. Endoscopic subscore, scored from 0 (normal or inactive disease) to 3 (severe disease, spontaneous bleeding, ulceration). The overall Adapted Mayo score ranges from 0 to 9 where higher scores represent more severe disease. For Substudy 3, clinical remission is defined as SFS ≤ 1 and not greater than Baseline, RBS of 0, and endoscopic subscore ≤ 1. In addition, evidence of friability during endoscopy in participants with otherwise "mild" endoscopic activity conferred an endoscopic subscore of 2.
Endoscopic remission was based on Simplified Endoscopic Score for Crohn's disease (SES-CD). The SES-CD assessed the size of mucosal ulcers, the ulcerated surface, the endoscopic extension and the presence of stenosis. SES-CD was based on endoscopic findings in 5 bowel segments (Ileum, right colon, transverse colon, left colon/sigmoid, and rectum). Each item was scored 0 to 3 per segment. The sum of the scores for each endoscopic variable ranged from 0 to 15, except for stenosis, where it varied between 0 and 11; total score ranged from 0 to 56. A lower score indicated better outcome. Endoscopic remission was defined as SES-CD ≤4 and at least two-point reduction versus Baseline of Study M13-740 and no subscore \>1 in any individual variable.
Clinical remission was defined as average daily stool frequency ≤1.5 and not worse than Baseline and average daily abdominal pain score ≤1.0 and not worse than baseline in Study M13-740. Abdominal pain was assessed using the CDAI component "abdominal pain" rated as none \[0\], mild \[1\], moderate \[2\], and severe \[3\]) (cumulative total over the past 7 days) as per the CDAI to calculate abdominal pain score; total score range from 0 to 105.
Endoscopic remission was determined using Simplified Endoscopic Score for Crohn's Disease (SES-CD). SES-CD subscores assess the following: presence and size of ulcers in 5 visualized bowel segments; extent of ulcerated surface in 5 visualized bowel segments; extent of affected surface in 5 visualized bowel segments; presence and type of narrowings in 5 visualized bowel segments. Subscores range from 0 to 15, and are summed for a total SES-CD score ranging from 0 to 56; higher scores indicate greater severity of mucosal inflammation. Endoscopic remission: SES-CD ≤ 4 and at least 2-point reduction versus Baseline and no subscore \> 1 in any individual variable.
Clinical remission: average daily stool frequency ≤ 1.5 and not worse than Baseline AND average daily abdominal pain ≤ 1.0 and not worse than Baseline. The very soft/liquid stool frequency and abdominal pain scores at a visit were the average of the daily values reported during the 7 usable days preceding the scheduled assessment visit. Abdominal Pain was rated on a 4-point scale from 0 (none) to 3 (severe).
Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR20 response criteria: 1. ≥ 20% improvement in 68-tender joint count; 2. ≥ 20% improvement in 66-swollen joint count; and 3. ≥ 20% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR50 response criteria: 1. ≥ 50% improvement in 68-tender joint count; 2. ≥ 50% improvement in 66-swollen joint count; and 3. ≥ 50% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
Participants who met the following 3 conditions for improvement from Baseline were classified as meeting the ACR70 response criteria: 1. ≥ 70% improvement in 68-tender joint count; 2. ≥ 70% improvement in 66-swollen joint count; and 3. ≥ 70% improvement in at least 3 of the 5 following parameters: * Physician global assessment of disease activity * Patient global assessment of disease activity * Patient assessment of pain * Health Assessment Questionnaire - Disability Index (HAQ-DI) * High-sensitivity C-reactive protein (hsCRP).
Satisfactory humoral response is defined as greater than or equal to 2-fold increase in antibody concentration from the vaccination Baseline in at least 6 out of the 12 pneumococcal antigens 1, 3, 4, 5, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F).
Response defined as at least 20% reduction (improvement) compared with baseline in tender joint count (TJC68), swollen joint count (SJC66), and at least 3 of the 5 remaining ACR core set measures: patient's assessment of pain, patient's global assessment of disease activity (PtGA); physician's global assessment of disease activity (PGA), Health Assessment Questionnaire - Disability Index (HAQ-DI), and high-sensitivity C-reactive protein (hs CRP). Last observation carried forward (LOCF) was used for missing data.
All patients that complete the open label dose-escalation phase and are randomized will be included in the efficacy analysis population. Efficacy of the Optimal Tolerated Dose (OTD) will be assessed by comparing the time to first occurrence of disease reactivation using Primary Immune Regulatory Deficiency (PIRD) score during the 8-week Randomized Withdrawal (RW) phase between the Upadacitinib and placebo groups. The PIRD score is a disease scoring method that capture the clinical manifestations of all PIRDs including JAK/STAT GOF disorders. The presence of a disease state and its severity is graded on a scale of 1-5. 1 indicates the absence of the disease. Disease flare is defined as an increase in PIRD score by ≥1 in disease manifestations.
All patients that receive at least one dose of study drug will be included in the analyses to evaluate safety and tolerability of the study drug. Safety and tolerability will be summarized for each phase of the study and will be assessed primarily based on adverse events of special interest. Assessment of safety and tolerability will primarily be done by calculating the percentage of patients with adverse events of special interest.
All patients that receive at least one dose of study drug will be included in the analyses to evaluate safety and tolerability of the study drug. Safety and tolerability will be summarized for each phase of the study and will be assessed based on organ toxicity. Organ toxicity will be assessed by clinical labs. Assessment of safety and tolerability will primarily be done by calculating the percentage of patients with organ specific toxicities.
Adverse Event is defined as any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a medicinal product.
Cmax is defined as the maximum observed plasma concentration for upadacitinib.
Tmax is defined as the time to maximum plasma concentration (Cmax) of upadacitinib.
The area under the plasma concentration-time curve is a method of measurement of the total exposure of a drug in plasma.
Clearance is defined as the volume of plasma cleared of the drug per unit time.
Half life of updadacitinib will be determined using non-compartmental method.
It is defined as the maximum observed plasma concentration (Cmax) for upadacitinib.
It is defined as the time to maximum plasma concentration (Tmax) of upadacitinib.
The area under the plasma concentration-time curve (AUCtau) is a method of measurement of the total exposure of a drug in plasma.
Clearance is defined the volume of plasma cleared of the drug per unit time.
An adverse event (AE) is defined as any untoward medical occurrence in a patient or clinical investigation participant administered a pharmaceutical product which does not necessarily have a causal relationship with this treatment. The investigator assesses the relationship of each event to the use of study drug as either probably related, possibly related, probably not related or not related. A serious adverse event (SAE) is an event that results in death, is life-threatening, requires or prolongs hospitalization, results in a congenital anomaly, persistent or significant disability/incapacity or is an important medical event that, based on medical judgment, may jeopardize the participant and may require medical or surgical intervention to prevent any of the outcomes listed above. Treatment-emergent adverse events (TEAEs) are defined as any event that began or worsened in severity after the first dose of study drug.
Blood pressure, pulse rate and body temperature
Hematology, Chemistry, and Urinalysis
ECGs done in triplicate; heart rate, PR interval, QT/QTc interval and QRS duration
Cmax, Tmax, AUC, elimination rate constant and half-life
| Arm | Type | Description |
|---|---|---|
| Upadacitinib (treatment arm) | ACTIVE_COMPARATOR | Participants will receive Upadacitinib 45mg daily, once a day, for at least five days. |
| Infliximab (standard care) | NO_INTERVENTION | Participants will receive standard care, which is Infliximab. |
| Group 1A: Upadacitinib Dose 1 | EXPERIMENTAL | Participants will receive upadacitinib Dose 1 during Period A (Baseline to Week 24) and continue the same treatment through Period B (Week 24 to Week 52) and Period C (Week 52 to Week 160). |
| Group 2A: Upadacitinib Dose 2 | EXPERIMENTAL | Participants will receive upadacitinib Dose 2 during Period A (Baseline to Week 24) and continue the same treatment through Period B (Week 24 to Week 52) and Period C (Week 52 to Week 160). |
| Group 3A: Matching Placebo | PLACEBO_COMPARATOR | Participants will receive matching placebo during Period A (Baseline to Week 24). Participants achieving SALT score ≤ 20 at Week 24 will remain on placebo until SALT score \> 20, then switch to blinded upadacitinib. Participants with SALT score \> 20 at Week 24 will be re-randomized to upadacitinib Dose 1 or Dose 2. |
| Group 1B: Upadacitinib Dose 1 | EXPERIMENTAL | Participants initially randomized to placebo in Period A with SALT score \> 20 at Week 24 will be re-randomized to receive upadacitinib Dose 1 during Period B and continue through Period C. |
| Group 2B: Upadacitinib Dose 2 | EXPERIMENTAL | Participants initially randomized to placebo in Period A with SALT score \> 20 at Week 24 will be re-randomized to receive upadacitinib Dose 2 during Period B and continue through Period C. |
| Group 1A: Upadacitinib Dose A | EXPERIMENTAL | Participants will receive upadacitinib dose A once daily for 52 weeks in Period A and Period B. |
| Group 2A: Upadacitinib Dose B | EXPERIMENTAL | Participants will receive upadacitinib dose B once daily for 52 weeks in Period A and Period B. |
| Group 3A: Upadacitinib Placebo | PLACEBO_COMPARATOR | Participants will receive upadacitinib placebo once daily for 24 weeks in Period A. |
| Group 1B: Upadacitinib Dose A | EXPERIMENTAL | Participants initially randomized to placebo (Period A) will be re-randomized to receive upadacitinib dose A once daily for 28 weeks in Period B. |
| Group 2B: Upadacitinib Dose B | EXPERIMENTAL | Participants initially randomized to placebo (Period A) will be re-randomized to receive upadacitinib dose B once daily for 28 weeks in Period B. |
| Period C: Upadacitinib Dose A Remains Dose A | EXPERIMENTAL | For participants initially randomized to dose A in Periods A and B and participants initially randomized to placebo who switched to dose A in Period B: participants with a Severity of Alopecia Tool (SALT) score \<= 10 at Week 52 (end of Period B) will remain on blinded upadacitinib dose A once daily in Period C for 52 weeks. |
| Period C: Upadacitinib Dose A to Dose B | EXPERIMENTAL | For participants initially randomized to dose A in Periods A and B and participants initially randomized to placebo who switched to dose A in Period B: participants with a SALT score \> 10 at Week 52 (end of Period B) will dose escalate to blinded upadacitinib dose B once daily in Period C for 52 weeks. |
| Period C: Upadacitinib Dose B Non-Sustained Responders | EXPERIMENTAL | For participants initially randomized to dose B in Periods A and B and participants initially randomized to placebo who switched to dose B in Period B: participants with a SALT score \> 10 at Week 40 or Week 52 will remain on blinded upadacitinib dose B once daily in Period C for 52 weeks. |
| Period C: Upadacitinib Dose B Sustained Responders | EXPERIMENTAL | For participants initially randomized to dose B in Periods A and B and participants initially randomized to placebo who switched to dose B in Period B: participants with a SALT score \<= 10 at Week 40 and Week 52 will receive blinded upadacitinib dose A once daily in Period C for 52 weeks. |
| Period C: Open-Label Upadacitinib Dose B | EXPERIMENTAL | Participants with no improvement or worsening from Baseline in their SALT score at the Week 40 visit or any scheduled visit thereafter will receive open-label upadacitinib dose B once daily for 52 weeks. |
| Upadacitinib + Topical Corticosteroids (TCS) | EXPERIMENTAL | Participants will be randomized to receive the upadacitinib daily adult equivalent dose in combination with TCS once a day (QD) during the double-blind and open label treatment periods for a total of 52 weeks |
| Placebo / Upadacitinib + Topical Corticosteroids (TCS) | PLACEBO_COMPARATOR | Participants will receive placebo orally once a day (QD) in combination with TCS for 12 weeks in the double-blind treatment period. At Week 12 participants will then be switched to receive open-label upadacitinib daily adult equivalent dose in combination with TCS. |
| Dupi-IR Cohort | EXPERIMENTAL | Participants in this cohort will receive upadacitinib medium dose. |
| Randomized Cohort | EXPERIMENTAL | Participants in the Randomized Cohort will be randomized to receive either medium dose upadacitinib daily adult equivalent dose, low dose upadacitinib daily adult equivalent dose or dupilumab every 2 weeks or 4 weeks (at the label-indicated dose and frequency). |
| Period 1: Open Label Induction Phase (Dose A) | EXPERIMENTAL | All participants in the open label induction phase of Period 1 will receive upadacitinib Dose A for 12 weeks based on body weight. |
| Period 1: Double-Blind Maintenance Phase (Dose B) | EXPERIMENTAL | Clinical responders per PCDAI at the end of open label induction phase of Period 1 will be randomly assigned to receive Dose B or C for 52 weeks (oral solution dose will be based on body weight) |
| Period 1: Double-Blind Maintenance Phase (Dose C) | EXPERIMENTAL | Clinical responders per PCDAI at the end of open label induction phase of Period 1 will be randomly assigned to receive either upadacitinib Dose C or B for 52 weeks (oral solution dose will be based on body weight) |
| Period 2: Open Label Long-Term Extension Phase Cohort 1 | EXPERIMENTAL | Participants receiving double-blind maintenance therapy with upadacitinib Dose B or upadacitinib Dose C daily in Period 1 who complete the Week 64 visit will receive upadacitinib Dose B daily for up to 156 weeks. |
| Period 2: Open Label Long-Term Extension Phase Cohort 2 | EXPERIMENTAL | Participants who were receiving rescue therapy with open-label upadacitinib Dose C during maintenance phase in Period 1 and completed the Week 64 visit will continue to receive upadacitinib Dose C daily for up to 156 weeks. |
| Period 2: Open Label Long-Term Extension Phase Cohort 3 | EXPERIMENTAL | Participants who did not achieve clinical response per PCDAI at Week 12 of Period 1 will receive an extended treatment with open-label upadacitinib Dose C daily for an additional 12 weeks. If they are responders after 12 weeks extended treatment, they will continue, otherwise they may be discontinued at the discretion of the investigator |
| Period 1: Upadacitinib Open Label Treatment | EXPERIMENTAL | Participants randomly assigned to receive Upadacitinib 15mg tablet once per day. Based on clinical response, participants randomized to Upadacitinib 15mg may have their dose increased to Upadacitinib 30mg starting at Week 2. |
| Period 1: Dupilumab Open Label Treatment | EXPERIMENTAL | Participants randomly assigned to receive Dupilumab 300mg SC injection once every other week for 8 weeks. |
| Period 2 Open Label: Upadacitinib < EASI 75 response | EXPERIMENTAL | Participants that were receiving Upadacitinib 15mg or 30mg and completed Period 1, will be allocated or continue to receive oral doses of Upadacitinib 30mg in Period 2 with a clinical response of \< EASI 75 at Week 8 |
| Period 2 Open Label: Upadacitinib ≥ EASI 75 Response | EXPERIMENTAL | Participants that were receiving Upadacitinib 15mg or 30mg and completed Period 1, will continue to receive the same oral doses of Upadacitinib in Period 2 with a clinical response of ≥ EASI 75 at Week 8 |
| Period 2 Open Label: Dupilumab ≥ EASI 75 Response | EXPERIMENTAL | Participants that were receiving Dupilumab 300mg and completed Period 1, will continue to receive Dupilumab 300mg SC injection in Period 2 with a clinical response of ≥ EASI 75 at Week 8 |
| Period 2 Open Label Period: Dupilumab < EASI 75 Response | EXPERIMENTAL | Participants that were receiving Dupilumab 300mg SC injections and completed Period 1, will receive oral doses of Upadacitinib 15mg in Period 2 with a clinical response of \< EASI 75 at Week 8 |
| Study 1, Period A: Group 1 | EXPERIMENTAL | Participants will receive upadacitinib 15 mg once daily for 48 weeks. |
| Study 1, Period A: Group 2 | PLACEBO_COMPARATOR | Participants will receive placebo once daily for 48 weeks. |
| Study 2, Period A: Group 1 | EXPERIMENTAL | Participants will receive upadacitinib 15 mg once daily for 48 weeks. |
| Study 2, Period A: Group 2 | PLACEBO_COMPARATOR | Participants will receive placebo once daily for 48 weeks. |
| Study 1, Period B: Group 1 Open-Label Extension Period | EXPERIMENTAL | Participants that were randomized to receive upadacitinib in Period A Group 1, will continue to receive upadacitinib 15 mg once daily for 112 weeks in Period B. |
| Study 1, Period B: Group 2 Open-Label Extension Period | EXPERIMENTAL | Participants that were randomized to receive placebo in Period A Group 2, will receive upadacitinib 15 mg once daily for 112 weeks in Period B. |
| Study 2, Period B: Group 1 Open-Label Extension Period | EXPERIMENTAL | Participants that were randomized to receive upadacitinib in Period A Group 1, will continue to receive upadacitinib 15 mg once daily for 112 weeks in Period B. |
| Study 2, Period B: Group 2 Open-Label Extension Period | EXPERIMENTAL | Participants that were randomized to receive placebo in Period A Group 2, will receive upadacitinib 15 mg once daily for 112 weeks in Period B. |
| (Optional) Study 3: Open Label Upadacitinib | EXPERIMENTAL | Participants will receive upadacitinib 15 mg once daily for 112 weeks. |
| (Optional) Study 3: Open Label Upadacitinib + NB-UVB | EXPERIMENTAL | Participants will receive 15 mg upadacitinib once daily for 112 weeks and Narrow-band ultraviolet B (NB-UVB) for up to 28 weeks. |
| Study 4: Upadacitinib 15 mg | EXPERIMENTAL | Eligible participants will be re-randomized to receive upadacitinib 15 mg once daily for 56 weeks. |
| Study 4: Upadacitinib 30 mg | EXPERIMENTAL | Eligible participants will be re-randomized to receive upadacitinib 30 mg once daily for 56 weeks. |
| Period 1- Open Label Induction Phase | EXPERIMENTAL | All participants in open label induction phase of Period 1 will receive upadacitinib Dose A for 8 weeks based on body weight. |
| Period 1- Double Blind Maintenance Phase | EXPERIMENTAL | Clinical responders at the end of open label induction phase of Period 1 will be randomly assigned to receive either upadacitinib Dose B or Dose C for 44 weeks based on body weight. |
| Period 2- Open Label Long Term Extension Phase Arm A | EXPERIMENTAL | Clinical non-responders outside of US after Period 1 induction phase will receive upadacitinib Dose A daily for 8 week extended induction phase in open label long term extension (OLE) Period 2. Clinical responders from extended induction phase in OLE will receive upadacitinib Dose B daily for up to 252 weeks in OLE period 2. |
| Period 2- Open Label Long Term Extension Phase Arm B | EXPERIMENTAL | Clinical non-responders in US after Period 1 induction phase or clinical responders with loss of response during maintenance phase will receive upadacitinib Dose B daily for up to 260 weeks in OLE Period 2. |
| Period 2- Long Term Extension Phase Arm C | EXPERIMENTAL | Clinical responders who complete Period 1 through Week 52 will receive upadacitinib Dose C daily for up to 260 weeks in OLE Period 2. |
| Study 1: Group 1 Upadacitinib Dose A | EXPERIMENTAL | Participants will receive upadacitinib Dose A once daily for 52 weeks in Period A and Period B. |
| Study 1: Group 2 Upadacitinib Dose B | EXPERIMENTAL | Participants will receive upadacitinib Dose B once daily for 52 weeks in Period A and Period B. |
| Study 1: Group 3 Placebo | EXPERIMENTAL | Participants will receive matching placebo once daily for 24 weeks in Period A. |
| Study 1: Group 4 Upadacitinib Dose A | EXPERIMENTAL | Participants initially randomized to placebo (Period A) with a SALT score \> 20 at Week 24 will be re-randomized to receive upadacitinib Dose A once daily for 28 weeks in Period B. |
| Study 1: Group 5 Upadacitinib Dose B | EXPERIMENTAL | Participants initially randomized to placebo (Period A) with a SALT score \> 20 at Week 24 will be re-randomized to receive upadacitinib Dose B once daily for 28 weeks in Period B. |
| Study 1: Group 6 Placebo | EXPERIMENTAL | Participants initially randomized to placebo with a SALT score ≤ 20 at Week 24 will continue on placebo through Week 160. |
| Study 2: Group 1 Upadacitinib Dose A | EXPERIMENTAL | Participants will receive upadacitinib Dose A once daily for 52 weeks in Period A and Period B. |
| Study 2: Group 2 Upadacitinib Dose B | EXPERIMENTAL | Participants will receive upadacitinib Dose B once daily for 52 weeks in Period A and Period B. |
| Study 2: Group 3 Placebo | EXPERIMENTAL | Participants will receive matching placebo once daily for 24 weeks in Period A. |
| Study 2: Group 4 Upadacitinib Dose A | EXPERIMENTAL | Participants initially randomized to placebo (Period A) with a SALT score \> 20 at Week 24 will be re-randomized to receive upadacitinib Dose A once daily for 28 weeks in Period B. |
| Study 2: Group 5 Upadacitinib Dose B | EXPERIMENTAL | Participants initially randomized to placebo (Period A) with a SALT score \> 20 at Week 24 will be re-randomized to receive upadacitinib Dose B once daily for 28 weeks in Period B. |
| Study 2: Group 6 Placebo | EXPERIMENTAL | Participants initially randomized to placebo with a SALT score ≤ 20 at Week 24 will continue on placebo through Week 160. |
| Study 3: Group 1 Upadacitinib Dose B (SALT > 20) | EXPERIMENTAL | Participants receiving upadacitinib Dose A with a SALT score \> 20 at Week 52 (end of Period B) of Study 1 or Study 2 will dose escalate to upadacitinib Dose B once daily for 108 weeks. |
| Study 3: Group 2 Upadacitinib Dose A (SALT ≤ 20) | EXPERIMENTAL | Participants receiving upadacitinib Dose A with a SALT score ≤ 20 at Week 52 (end of Period B) of Study 1 or Study 2 will remain on upadacitinib Dose A once daily for 108 weeks. |
| Study 3: Group 3 Upadacitinib Dose B (Non-Sustained) | EXPERIMENTAL | Participants who end Period B on upadacitinib Dose B with a with a SALT score \> 20 at Week 40 or Week 52 of Study 1 or Study 2 will remain on upadacitinib Dose B once daily for 108 weeks. |
| Study 3: Group 4 Upadacitinib Dose B (Sustained) | EXPERIMENTAL | Participants who end Period B on upadacitinib Dose B with a with a SALT score ≤ 20 at Week 40 and Week 52 of Study 1 or Study 2 will be re-randomized to receive upadacitinib Dose B once daily for 108 weeks. |
| Study 3: Group 5 Upadacitinib Dose A (Sustained) | EXPERIMENTAL | Participants who end Period B on upadacitinib Dose B with a with a SALT score ≤ 20 at Week 40 and Week 52 of Study 1 or Study 2 will be re-randomized to receive upadacitinib Dose A once daily for 108 weeks. |
| Study 4: Group 1 Upadacitinib Dose A | EXPERIMENTAL | US only adolescent participants will receive upadacitinib Dose A once daily for 52 weeks in Period A and Period B. |
| Study 4: Group 2 Upadacitinib Dose B | EXPERIMENTAL | US only adolescent participants will receive upadacitinib Dose B once daily for 52 weeks in Period A and Period B. |
| Study 4: Group 3 Placebo | EXPERIMENTAL | US only adolescent participants will receive matching placebo once daily for 24 weeks in Period A. |
| Study 4: Group 4 Upadacitinib Dose A | EXPERIMENTAL | Participants initially randomized to placebo (Period A) with a SALT score \> 20 at Week 24 will be re-randomized to receive upadacitinib Dose A once daily for 28 weeks in Period B. |
| Study 4: Group 5 Upadacitinib Dose B | EXPERIMENTAL | Participants initially randomized to placebo (Period A) with a SALT score \> 20 at Week 24 will be re-randomized to receive upadacitinib Dose B once daily for 28 weeks in Period B. |
| Study 4: Group 6 Placebo | EXPERIMENTAL | Participants initially randomized to placebo with a SALT score ≤ 20 at Week 24 will continue on placebo through Week 160. |
| Cohort 1 Upadacitinib | EXPERIMENTAL | Participants will receive upadacitinib for 52 weeks. |
| Cohort 1 Tocilizumab | ACTIVE_COMPARATOR | Participants will receive tocilizumab for 52 weeks. |
| Cohort 2 Upadacitinib | EXPERIMENTAL | Participants will receive upadacitinib for 52 weeks. |
| Study 1- Upadacitinib Dose A | EXPERIMENTAL | Participants will receive upadacitinib dose A once daily for 52 weeks. |
| Study 1- Placebo | PLACEBO_COMPARATOR | Participants will receive upadacitinib matching placebo once daily for 52 weeks. |
| Study 2- Upadacitinib Dose A | EXPERIMENTAL | Participants will receive upadacitinib dose A once daily for 52 weeks. |
| Study 2- Placebo | PLACEBO_COMPARATOR | Participants will receive upadacitinib matching placebo once daily for 52 weeks. |
| Study 3- Low Disease Activity Upadacitinib (LDA) Dose A | EXPERIMENTAL | Participants in the upadacitinib arms from Study 1 or Study 2 with LDA will receive upadacitinib dose A once daily for 52 weeks. |
| Study 3- Low Disease Activity Upadacitinib Dose B | EXPERIMENTAL | Participants in the upadacitinib arms from Study 1 or Study 2 with LDA will receive upadacitinib dose B once daily for 52 weeks. |
| Study 3- No LDA Upadacitinib Dose A | EXPERIMENTAL | Participants in the upadacitinib arms from Study 1 or Study 2 with no LDA will receive upadacitinib dose A once daily for 52 weeks. |
| Study 3- Upadacitininb Dose A | EXPERIMENTAL | Participants in the placebo arms of Study 1 or Study 2 will receive upadacitinib Dose A once daily for 52 weeks. |
| Study 3- Open Label Upadacitinib Dose A | EXPERIMENTAL | Participants who experience a suspected systemic lupus erythematosus (SLE) flare may receive open label upadacitinib Dose A once daily for the remainder of the study. |
| Study 3- Open Label Upadacitinib Dose B | EXPERIMENTAL | Participants who reach \>= 65 years of age and are still on study drug may receive open-label upadacitinib Dose B once daily, and participants who experience a suspected SLE flare while on upadacitinib Dose B may receive upadacitinib Dose A for the remainder of the study. |
| Study 4- Upadacitinib Dose A | EXPERIMENTAL | Participants receiving upadacitinib Dose A in Study 3 will continue on this dose once daily for 104 weeks. |
| Study 4- Upadacitinib Dose B | EXPERIMENTAL | Participants receiving upadacitinib Dose B in Study 3 will continue on this dose once daily for 104 weeks. |
| Period 1: Upadacitinib Dose A | EXPERIMENTAL | Participants will receive Upadicitinib Dose A once daily for 16 weeks. |
| Period 1: Placebo | PLACEBO_COMPARATOR | Participants will receive Placebo once daily for 16 weeks. |
| Period 2: Group 1 - Upadacitinib Dose A | EXPERIMENTAL | Participants who were randomized to placebo in Period 1 who did not achieve HiSCR 50 (clinical non-responder, CNR) at Week 16 will receive Upadacitinib Dose A once daily for 20 weeks. |
| Period 2: Group 2 - Placebo | PLACEBO_COMPARATOR | Participants who were randomized to placebo in Period 1 who achieve HiSCR 50 (clinical responder, CR) at Week 16 will continue to receive placebo once daily for 20 weeks. |
| Period 2: Group 3 - Upadacitinib Dose A | EXPERIMENTAL | Participants who were randomized to upadacitinib Dose A in Period 1 who did not achieve HiSCR 50 (CNR) at Week 16 will continue to receive upadacitinib Dose A once daily for 20 weeks. |
| Period 2: Group 4 - Upadacitinib Dose A | EXPERIMENTAL | Participants who were randomized to upadacitinib Dose A in Period 1 who achieve HiSCR 50 (CR) at Week 16 will receive upadacitinib Dose A once daily for 20 weeks. |
| Period 2: Group 5 - Upadacitinib Dose B | EXPERIMENTAL | Participants who were randomized to upadacitinib Dose A in Period 1 who achieve HiSCR 50 (CR) at Week 16 will receive upadacitinib Dose B once daily for 20 weeks. |
| Period 2: Group 6 - Placebo | EXPERIMENTAL | Participants who were randomized to upadacitinib Dose A in Period 1 who achieve HiSCR 50 (CR) at Week 16 will receive placebo once daily for 20 weeks. |
| Period 3: Long-Term Extension | EXPERIMENTAL | Eligible participants will continue to receive upadacitinib or placebo for 68 weeks. Participants will be followed-up for approximately 30 days. |
| Upadacitinib+ Adalimumab matching Placebo | EXPERIMENTAL | Participants will receive upadacitinib once a day along with matching placebo for adalimumab at eow (every other week) in Period 1. Eligible participants will continue to receive same study treatment in Period 2 as assigned in Period 1. |
| Adalimumab + Upadacitinib matching Placebo | EXPERIMENTAL | Participants will receive adalimumab at eow (every other week) along with matching placebo for upadacitinib once a day in Period 1. Eligible participants will continue to receive same study treatment in Period 2 as assigned in Period 1. |
| Dupilumab (Period 1) | EXPERIMENTAL | Adult participants received a loading dose of 600 mg dupilumab by subcutaneous (SC) injection at the Baseline visit followed by 300 mg dupilumab SC every other week (EOW) until Week 16. Adolescents (12 to 17 years of age and weighing at least 40 kg) received treatment according to their body weight. Participants weighing 40 to \< 60 kg received a loading dose of 400 mg dupilumab SC at the Baseline visit followed by 200 mg SC EOW until Week 16. Those weighing 60 kg or more received a loading dose of 600 mg dupilumab SC at the Baseline visit followed by 300 mg dupilumab SC EOW until Week 16. |
| Upadacitinib (Period 1) | EXPERIMENTAL | Participants received 15 mg upadacitinib orally once a day (QD) up to Week 16. Starting at Week 4, participants had their dose increased to 30 mg QD if they had a \< 50% reduction from Baseline in Eczema Area and Severity Index (EASI 50) response or a \< 4-point improvement from Baseline in Worst Pruritus Numerical Rating Scale (WP-NRS; weekly average). Starting at Week 8, participants had their dose increased to 30 mg QD if they had a \< EASI 75 response. |
| Dupilumab -> Upadacitinib (Period 2) | EXPERIMENTAL | At Week 16, participants receiving dupilumab as per its label in Period 1 were reassigned based on their Eczema Area and Severity Index (EASI) response. Those with \< EASI 75 were offered the option to receive oral doses of upadacitinib 15 mg QD in Period 2 up to Week 32. Those with ≥ EASI 75 completed the end of study procedures. Starting at Week 20, participants with \< EASI 75 or a \< 4-point improvement from Baseline in Worst Pruritus Numerical Rating Scale (WP-NRS; weekly average) had their dose increased to 30 mg QD up to Week 32. |
| Upadacitinib -> Upadacitinib 30 mg (Period 2) | EXPERIMENTAL | At Week 16, participants receiving upadacitinib in Period 1 were reassigned based on their Eczema Area and Severity Index (EASI) response. Those with \< EASI 75 were allocated or continued to receive upadacitinib 30 mg QD in Period 2. Those with ≥ EASI 75 completed the end of study procedures. |
| Arm 2: Placebo for Upadacitinib | EXPERIMENTAL | Participants will be administered placebo once daily (QD) along with prednisolone. |
| Arm 1: Upadacitinib | EXPERIMENTAL | Participants will be administered updadacitinib once daily (QD) along with prednisolone. |
| Upadacitinib | EXPERIMENTAL | Participants will be administered with upadacitinib once daily (QD) |
| Study 1: Upadacitinib 15 mg | EXPERIMENTAL | Participants receive 15 mg upadacitinib orally once a day for 104 weeks. Participants who flare after 104 weeks will receive open-label upadacitinib once daily from the time of flare for 24 weeks (re-treatment). |
| Study 1: Placebo | PLACEBO_COMPARATOR | Participants receive matching placebo for 14 weeks and then switch to receive 15 mg upadacitinib orally once a day for 90 weeks. Participants who flare after 104 weeks will receive open-label upadacitinib once daily from the time of flare for 24 weeks (re-treatment). |
| Study 2: Upadacitinib 15 mg | EXPERIMENTAL | Participants receive 15 mg upadacitinib orally once a day for 104 weeks. Participants who flare after 104 weeks will receive open-label upadacitinib once daily from the time of flare for 24 weeks (re-treatment). |
| Study 2: Placebo | PLACEBO_COMPARATOR | Participants receive matching placebo for 52 weeks and then switch to receive 15 mg upadacitinib orally once a day for 52 weeks. Participants who flare after 104 weeks will receive open-label upadacitinib once daily from the time of flare for 24 weeks (re-treatment). |
| Upadacitinib 30 mg QD | EXPERIMENTAL | Participants will receive 30 mg upadacitinib orally once a day (QD) up to Week 24 and placebo to dupilumab by subcutaneous injection every other week from Baseline to Week 22. |
| Dupilumab 300 mg EOW | EXPERIMENTAL | Participants will receive a loading dose of 600 mg dupilumab by subcutaneous (SC) injection on Day 1 followed by 300 mg dupilumab SC every other week (EOW) until Week 22 and placebo to upadacitinib orally QD up to Week 24. |
| Placebo + 52-week CS taper | PLACEBO_COMPARATOR | Participants received placebo tablets for upadacitinib administered orally once daily (QD) for 52 weeks and a 52-week corticosteroid (CS) taper regimen during Period 1. |
| 7.5 mg Upadacitinib + 26-week CS taper | EXPERIMENTAL | Participants received 7.5 mg upadacitinib tablets administered orally once daily (QD) for 52 weeks and a 26-week corticosteroid (CS) taper regimen during Period 1. |
| 15 mg Upadacitinib + 26-week CS taper | EXPERIMENTAL | Participants received 15 mg upadacitinib tablets administered orally once daily (QD) for 52 weeks and a 26-week corticosteroid (CS) taper regimen during Period 1. |
| Placebo + 52-week CS taper -> Placebo | PLACEBO_COMPARATOR | Participants who achieved sustained remission for at least 24 weeks prior to the Week 52 visit (at the end of Period 1) OR at remission at the Week 52 visit only who were assigned to placebo tablets for upadacitinib administered orally once daily (QD) in Period 1 continued to receive placebo tablets for upadacitinib administered orally once daily (QD) in Period 2. |
| 7.5 mg Upadacitinib + 26-week CS taper -> 7.5 mg Upadacitinib | EXPERIMENTAL | Participants received 7.5 mg upadacitinib tablets administered orally once daily (QD) in Period 2. |
| 7.5 mg Upadacitinib + 26-week CS taper -> Placebo | EXPERIMENTAL | Participants received placebo tablets for upadacitinib administered orally once daily (QD) in Period 2. |
| 15 mg Upadacitinib + 26-week CS taper -> 15 mg Upadacitinib | EXPERIMENTAL | Participants received 15 mg upadacitinib tablets administered orally once daily (QD) in Period 2. |
| 15 mg Upadacitinib + 26-week CS taper -> Placebo | EXPERIMENTAL | Participants received placebo tablets for upadacitinib administered orally once daily (QD) in Period 2. |
| Upadacitinib 45 mg | EXPERIMENTAL | Participants received 45 mg upadacitinib once daily (QD) for 8 weeks. Participants who did not achieve clinical response per Adapted Mayo score at Week 8 received upadacitinib 45 mg once daily for 8 additional weeks in the open-label extension period. |
| Placebo | PLACEBO_COMPARATOR | Participants received placebo matching to upadacitinib once daily for 8 weeks. Participants who did not achieve clinical response per Adapted Mayo score at Week 8 received upadacitinib 45 mg once daily for 8 weeks in the open-label extension period. |
| Arm A | EXPERIMENTAL | Upadacitinib Dose A is administered once daily along with Topical Corticosteroids (TCS). |
| Arm B | EXPERIMENTAL | Upadacitinib Dose B is administered once daily along with Topical Corticosteroids (TCS). |
| Arm C | EXPERIMENTAL | Placebo administered once daily and TCS followed by Upadacitinib Dose A once daily along with TCS. |
| Arm D | EXPERIMENTAL | Placebo administered once daily and TCS followed by Upadacitinib Dose B once daily along with TCS. |
| Placebo / Upadacitinib | PLACEBO_COMPARATOR | Participants will receive placebo orally once a day (QD) for 16 weeks in the double-blind treatment period. At Week 16 participants will be re-randomized to receive either upadacitinib 15 mg or upadacitinib 30 mg QD up to Week 260. |
| Upadacitinib 15 mg QD | EXPERIMENTAL | Participants will receive upadacitinib 15 mg orally once a day for up to 260 weeks. |
| Placebo / Upadacitinib + Topical Corticosteroids | PLACEBO_COMPARATOR | Participants will receive placebo orally once a day (QD) for 16 weeks in the double-blind treatment period. At Week 16 participants will be re-randomized to receive either upadacitinib 15 mg or upadacitinib 30 mg QD up to Week 260. Participants will also receive concomitant topical corticosteroids following a step-down regimen through Week 52. |
| Upadacitinib 15 mg QD + Topical Corticosteroids | EXPERIMENTAL | Participants will receive upadacitinib 15 mg orally once a day for up to 260 weeks. Participants will also receive concomitant topical corticosteroids following a step-down regimen through Week 52. |
| Upadacitinib 30 mg QD + Topical Corticosteroids | EXPERIMENTAL | Participants will receive upadacitinib 30 mg orally once a day for up to 260 weeks. Participants will also receive concomitant topical corticosteroids following a step-down regimen through Week 52. |
| Long-Term Extension | EXPERIMENTAL | Participants who reach Week 260 in Studies M16-045, M18-891, and M16-047 will have the opportunity to roll over into the blinded LTE period of M16-047 to continue receiving the same daily dose of upadacitinib for up to Week 524. |
| Substudy 1: Cohort 1 Upadacitinib Dose A | EXPERIMENTAL | This is a maintenance group which includes participants who achieved clinical response to upadacitinib in studies M14-431 and M14-433 and will receive upadacitinib dose A for 52 weeks. |
| Substudy 1: Cohort 1 Upadacitinib Dose B | EXPERIMENTAL | This is a maintenance group which includes participants who achieved clinical response to upadacitinib in studies M14-431 and M14-433 and will receive upadacitinib dose B for 52 weeks. |
| Substudy 1: Cohort 1 Placebo | EXPERIMENTAL | This is a maintenance group which includes participants who achieved clinical response to upadacitinib in studies M14-431 and M14-433 and will receive placebo for 52 weeks. |
| Substudy 1: Cohort 2 Placebo | EXPERIMENTAL | This is a maintenance group which includes participants who received double-blind placebo in studies M14-431 and M14-433 and achieved clinical response will continue to receive blinded placebo for 52 Weeks. |
| Substudy 1: Cohort 3 Upadacitinib Dose B | EXPERIMENTAL | This is a maintenance group which includes participants who achieved clinical response to upadacitinib from the extended treatment period of studies M14-431 and M14-433 and will receive upadacitinib Dose B for 52 Weeks. |
| Substudy 2: Cohort 4 Upadacitinib Dose B | EXPERIMENTAL | This is a long-term extension group which includes participants who achieved clinical response in the open-label extended treatment period of study M14-431 and will receive upadacitinib dose B for 240 weeks. |
| Substudy 2: Cohort 5 Upadacitinib Dose A | EXPERIMENTAL | This is a long-term extension group which includes participants who complete Substudy 1 and will receive upadacitinib dose A for 240 weeks. |
| Substudy 2: Cohort 5 Upadacitinib Dose B | EXPERIMENTAL | This is a long-term extension group which includes participants who complete Substudy 1 and will receive upadacitinib dose B for 240 weeks. |
| Substudy 2: Cohort 5 Placebo | EXPERIMENTAL | This is a long-term extension group which includes participants who complete Substudy 1 and will receive placebo for 240 weeks. |
| Placebo / Upadacitinib 15 mg | PLACEBO_COMPARATOR | Participants randomized to receive placebo once daily for 12 weeks in Period 1 followed by upadacitinib 15 mg once daily for up to 52 weeks in Period 2. |
| Upadacitinib 15 mg | EXPERIMENTAL | Participants randomized to receive upadacitinib 15 mg once daily for 12 weeks in Period 1 and up to an additional 52 weeks in Period 2. |
| Part 1 (Double-blind): Placebo | PLACEBO_COMPARATOR | Participants received upadacitinib matching placebo tablets, orally, once daily (QD) for 12 weeks during the Double-blind (DB) Induction Period. |
| Part 1 (Double-blind): Upadacitinib 45 mg | EXPERIMENTAL | Participants received upadacitinib 45 mg tablets, orally, QD for 12 weeks during the DB Induction Period. |
| Part 2 (Open-label): Upadacitinib 45 mg | EXPERIMENTAL | Participants received upadacitinib 45 mg tablets, orally, QD for 12 weeks during the Open-label (OL) Induction Period. |
| Part 3 (Extended Treatment DB): Upadacitinib 45 mg From Part 1 DB Placebo | EXPERIMENTAL | Participants received upadacitinib 45 mg tablets, orally, QD for 12 weeks (until Week 24) during the Extended Treatment (ET) Period. Participants who received placebo in Part 1 and did not achieve clinical response at Week 12 were included in this group. |
| Part 3 (Extended Treatment DB): Upadacitinib 30 mg From Part 1 DB Upadacitinib 45 mg | EXPERIMENTAL | Participants received upadacitinib 30 mg tablets, orally, QD for 12 weeks (until Week 24) during the ET Period. Participants who received DB upadacitinib 45 mg in Part 1 and did not achieve clinical response at Week 12 were included in this group. |
| Part 3 (Extended Treatment OL): Upadacitinib 30 mg From Part 2 OL Upadacitinib 45 mg | EXPERIMENTAL | Participants received upadacitinib 30 mg tablets, orally, QD for 12 weeks (until Week 24) during the ET Period. Participants who received OL upadacitinib 45 mg during Part 2 and did not achieve clinical response at Week 12 were included in this group. |
| Primary Cohort: Abatacept/Upadacitinib 15 mg QD | ACTIVE_COMPARATOR | Period 1: 500 mg (for body weight \<60 kg); 750 mg (for body weight 60-100 kg); and 1000 mg (for body weight \>100 kg) IV infusion at Baseline, Week 2, Week 4, Week 8, Week 12, Week 16 and Week 20. Period 2: open label upadacitinib 15 mg QD for 192 weeks. |
| Primary Cohort: Upadacitinib 15 mg QD/Upadacitinib 15 mg QD | EXPERIMENTAL | Period 1: One 15 mg upadacitinib oral tablet QD for 24 weeks. Period 2: open label upadacitinib 15 mg QD for 192 weeks. |
| 30 mg Cohort: Upadacitinib 30 mg QD/Upadacitinib 30 mg QD | EXPERIMENTAL | Period 1: One upadacitinib 30 mg oral tablet QD for 24 weeks. Period 2: open label upadacitinib 30 mg (reduced to 15 mg per Amendment 5) QD for 192 weeks. |
| 30 mg Cohort: Abatacept/Upadacitinib 30 mg QD | ACTIVE_COMPARATOR | Period 1: 500 mg (for body weight \<60 kg); 750 mg (for body weight 60-100 kg); and 1000 mg (for body weight \>100 kg) IV infusion at Baseline, Week 2, Week 4, Week 8, Week 12, Week 16 and Week 20. Period 2: open label upadacitinib 30 mg (reduced to 15 mg per Amendment 5) QD for 192 weeks. |
| Placebo / Upadacitinib 30 mg | PLACEBO_COMPARATOR | Administered once daily. |
| Upadacitinib 30 mg | EXPERIMENTAL | Administered once daily. |
| Participants receiving Upadacitinib (ABT-494) Dose A | EXPERIMENTAL | The participants in this arm will receive Upadacitinib (ABT-494) dose A. |
| Participants receiving Upadacitinib (ABT-494) Dose B | EXPERIMENTAL | The participants in this arm will receive Upadacitinib (ABT-494) dose B. |
| Participants receiving Upadacitinib (ABT-494) Dose A or Dose B | EXPERIMENTAL | The participants in this arm will receive Upadacitinib (ABT-494) dose A or dose B. |
| Participants receiving Placebo | EXPERIMENTAL | The participants in this arm will receive placebo until study is unblinded. |
| Participants receiving Upadacitinib (ABT-494) Dose C | EXPERIMENTAL | The participants in this arm will receive Upadacitinib (ABT-494) dose C. |
| Methotrexate / Upadacitinib 30 mg | EXPERIMENTAL | Period 1: Participants receive methotrexate once weekly and placebo to upadacitinib once daily for 14 weeks. Period 2: Participants receive upadacitinib 30 mg once daily until implementation of Protocol Amendment 5 when participants begin to receive upadacitinib 15 mg once daily up to Week 260. |
| Methotrexate / Upadacitinib 15 mg | EXPERIMENTAL | Period 1: Participants receive methotrexate once weekly and placebo to upadacitinib for 14 weeks. Period 2: Participants receive upadacitinib 15 mg once daily up to Week 260. |
| Placebo / Upadacitnib 15 mg | PLACEBO_COMPARATOR | Period 1: Participants receive placebo once daily for 12 weeks followed by upadacitinib 15 mg once daily for 12 weeks. Period 2: Participants will continue on upadacitinib 15 mg once daily from Week 24 to Week 260. |
| Placebo / Upadacitnib 30 mg | PLACEBO_COMPARATOR | Period 1: Participants receive placebo once daily for 12 weeks followed by upadacitinib 30 mg once daily for 12 weeks. Period 2: Participants continue on upadacitinib 30 mg once daily until implementation of Protocol Amendment 4, then participants begin to receive upadacitinib 15 mg once daily up to Week 260. |
| Methotrexate | ACTIVE_COMPARATOR | Period 1: Participants will receive placebo to upadacitinib once daily and methotrexate once weekly for 48 weeks. Period 2: Participants will continue on placebo to upadacitinib once daily and methotrexate once weekly until the study is unblinded, after which participants will receive open-label methotrexate up to Week 260. |
| Upadacitinib 7.5 mg (Japan-only) | EXPERIMENTAL | Period 1: Participants will receive upadacitinib 7.5 mg once daily and placebo to methotrexate once weekly for 48 weeks. Period 2: Participants will continue on upadacitinib 7.5 mg once daily and placebo to methotrexate once weekly until the study is unblinded, after which participants will receive open-label upadacitinib 7.5 mg up to Week 260. |
| Upadacitinib 30mg | EXPERIMENTAL | Participants randomly assigned to this arm will receive the active drug for the entire 24 week treatment period. During the first 12 weeks, participants will receive blinded upadacitinib 30mg daily (meaning the participant and study team will not know which medication the participant receives) followed by open-label upadacitinib 30mg daily for 12 weeks. |
| Placebo, followed by Upadacitinib 30mg | OTHER | Participants randomly assigned to this arm will receive placebo for 12 weeks, followed by upadacitinib 30mg for 12 weeks. During the first 12 weeks, participants will receive blinded placebo daily (meaning the participant and study team will not know which medication the participant receives) followed by open-label upadacitinib 30mg daily for 12 weeks. |
| Upa 22 mg Period 1, then Upa 22 mg Period 2 | EXPERIMENTAL | Participants received upadacitinib 22 mg administered orally once a day (QD) as tablets for 24 weeks during Period 1. Participants then received upadacitinib 22 mg administered orally once a day (QD) as tablets for 28 weeks during Period 2. |
| Upa 11 mg Period 1, then Upa 11 mg Period 2 | EXPERIMENTAL | Participants received upadacitinib 11 mg administered orally once a day (QD) as tablets for 24 weeks during Period 1. Participants then received upadacitinib 11 mg administered orally once a day (QD) as tablets for 28 weeks during Period 2. |
| Upa 6 mg Period 1, then Upa 6 mg Period 2 | EXPERIMENTAL | Participants received upadacitinib 6 mg administered orally once a day (QD) as tablets for 24 weeks during Period 1. Participants then received upadacitinib 6 mg administered orally once a day (QD) as tablets for 28 weeks during Period 2. |
| Placebo Period 1, then Upa 22 mg Period 2 | EXPERIMENTAL | Participants received Placebo for upadacitinib administered orally once a day (QD) as tablets for 24 weeks during Period 1. Participants then received upadacitinib 22 mg administered orally once a day (QD) as tablets for 28 weeks during Period 2. |
| Placebo Period 1, then Upa 11 mg Period 2 | EXPERIMENTAL | Participants received Placebo for upadacitinib administered orally once a day (QD) as tablets for 24 weeks during Period 1. Participants then received upadacitinib 11 mg administered orally once a day (QD) as tablets for 28 weeks during Period 2. |
| Placebo followed by Upadacitinib 15 mg | EXPERIMENTAL | Participants will receive matching placebo orally once a day for 12 weeks (Period 1) followed by 15 mg upadacitinib orally once a day for 36 weeks (Period 2). |
| Upadacitinib 7.5 mg | EXPERIMENTAL | Participants randomized to receive upadacitinib 7.5 mg QD for 16 weeks in Period 1. At Week 16 participants were re-randomized to receive 7.5 mg upadacitinib or placebo QD for 72 weeks in Period 2. |
| SS1: Placebo | PLACEBO_COMPARATOR | During the 8-week induction phase in Substudy 1, participants received placebo for upadacitinib film-coated tablets once daily by mouth (QD) for 8 weeks. |
| SS1: Upadacitinib 7.5 mg | EXPERIMENTAL | During the 8-week induction phase in Substudy 1, participants received 7.5 mg upadacitinib film-coated tablets once daily by mouth (QD) for 8 weeks. |
| SS1: Upadacitinib 15 mg | EXPERIMENTAL | During the 8-week induction phase in Substudy 1, participants received 15 mg upadacitinib film-coated tablets once daily by mouth (QD) for 8 weeks. |
| SS1: Upadacitinib 30 mg | EXPERIMENTAL | During the 8-week induction phase in Substudy 1, participants received 30 mg upadacitinib film-coated tablets once daily by mouth (QD) for 8 weeks. Additional participants were enrolled during the Substudy 1 analysis period and received 30 mg upadacitinib film-coated tablets once daily by mouth (QD) for 4 weeks. |
| SS1: Upadacitinib 45 mg | EXPERIMENTAL | During the 8-week induction phase in Substudy 1, participants received 45 mg upadacitinib film-coated tablets once daily by mouth (QD) for 8 weeks. Additional participants were enrolled during the Substudy 1 analysis period and received 45 mg upadacitinib film-coated tablets once daily by mouth (QD) for 4 weeks. |
| SS2: Placebo/Upadacitinib 45 mg | EXPERIMENTAL | During the Substudy 2 Part 1 induction period, participants received placebo for upadacitinib film-coated tablets once daily by mouth (QD) for 8 weeks. Participants who did not achieve clinical response at Week 8 of Part 1 were enrolled in an open-label extended treatment period and received 45 mg upadacitinib film-coated tablets once daily by mouth (QD) for an additional 8 weeks. |
| SS2: Upadacitinib 45 mg/Upadacitinib 45 mg | EXPERIMENTAL | During the Substudy 2 Part 1 induction period, participants received 45 mg upadacitinib film-coated tablets once daily by mouth (QD) for 8 weeks. Participants who did not achieve clinical response at Week 8 of Part 1 were enrolled in an open-label expended treatment period and received 45 mg upadacitinib film-coated tablets once daily by mouth (QD) for an additional 8 weeks. |
| SS3: M14-675 clinical responders | EXPERIMENTAL | Participants in Study M14-675 (NCT03653026) who achieved clinical response defined by Adapted Mayo Score at Week 8 or Week 16 in that study and did not meet any study discontinuation criteria were eligible to enroll into Substudy 3. Participants were re-randomized and treated with a blinded treatment assignment (15 mg upadacitinib film-coated tablets once daily by mouth \[QD\], or 30 mg upadacitinib film-coated tablets QD, or placebo for upadacitinib film-coated tablets QD) for up to 52 weeks. |
| Upadacitinib (ABT-494) Dose B | EXPERIMENTAL | Open label dose B QD |
| Upadacitinib (ABT-494) Dose A | EXPERIMENTAL | Open label dose A once daily (QD) |
| Placebo / Upadacitinib 7.5 mg | EXPERIMENTAL | Period 1: Participants will receive placebo once daily for 12 weeks. Period 2: Participants will receive Upadacitinib 7.5 mg once daily for 248 weeks. |
| Upadacitinib 7.5 mg / Upadacitinib 7.5 mg | EXPERIMENTAL | Period 1: Participants will receive upadacitinib 7.5 mg once daily for 12 weeks. Period 2: Participants will receive upadacitinib 7.5 mg once daily for 248 weeks. |
| Upadacitinib 15 mg / Upadacitinib 15 mg | EXPERIMENTAL | Period 1: Participants will receive upadacitinib 15 mg once daily for 12 weeks. Period 2: Participants will receive upadacitinib 15 mg once daily for 248 weeks. |
| Upadacitinib 30 mg / Upadacitinib 30 mg | EXPERIMENTAL | Period 1: Participants will receive upadacitinib 30 mg once daily for 12 weeks. Period 2: Participants will receive upadacitinib 30 mg once daily until regulatory approval of RA indication in Japan at which point they will switch to receive upadacitinib 15 mg once daily. Participants will receive upadacitinib for 248 weeks. |
| Induction Period ABT-494 Twice Daily Medium/High Dose | ACTIVE_COMPARATOR | Induction Period ABT-494 Twice Daily Medium/High Dose orally dosed twice a day |
| Extension Phase ABT-494 High Dose | ACTIVE_COMPARATOR | Extension Phase ABT-494 High Dose orally dosed twice a day |
| Induction Period Placebo | PLACEBO_COMPARATOR | Induction Period Placebo orally dosed twice a day |
| Induction Period ABT-494 Low Dose | ACTIVE_COMPARATOR | Induction Period ABT-494 Low Dose orally dosed twice a day |
| Induction Period ABT-494 Once Daily Medium/High Dose | ACTIVE_COMPARATOR | Induction Period ABT-494 Once Daily Medium/High Dose orally dosed once a day |
| Extension Phase ABT-494 Low Dose | ACTIVE_COMPARATOR | Extension Phase ABT-494 Low Dose orally dosed twice a day |
| Induction Period ABT-494 High Dose | ACTIVE_COMPARATOR | Induction Period ABT-494 High Dose orally dosed twice a day |
| Induction Period ABT-494 Low/Medium Dose | ACTIVE_COMPARATOR | Induction Period ABT-494 Low/Medium Dose orally dosed twice a day |
| Extension Phase ABT-494 Medium Dose | ACTIVE_COMPARATOR | Extension Phase ABT-494 Medium Dose orally dosed twice a day |
| Upadacitinib 3 mg BID | EXPERIMENTAL | Participants received 3 mg upadacitinib twice daily (BID) for 12 weeks. |
| Upadacitinib 6 mg BID | EXPERIMENTAL | Participants received 6 mg upadacitinib twice daily (BID) for 12 weeks. |
| Upadacitinib 12 mg BID | EXPERIMENTAL | Participants received 12 mg upadacitinib twice daily (BID) for 12 weeks. |
| Upadacitinib 18 mg BID | EXPERIMENTAL | Participants received 18 mg upadacitinib twice daily (BID) for 12 weeks. |
| Upadacitinib 24 mg QD | EXPERIMENTAL | Participants received 24 mg upadacitinib once daily (QD) for 12 weeks. |
| Placebo BID | PLACEBO_COMPARATOR | Placebo twice daily (BID) for 12 weeks. |
| ABT-494 3 mg BID | EXPERIMENTAL | ABT-494 3 mg twice daily (BID) for 12 weeks. |
| ABT-494 6 mg BID | EXPERIMENTAL | ABT-494 6 mg twice daily (BID) for 12 weeks. |
| ABT-494 12 mg BID | EXPERIMENTAL | ABT-494 12 mg twice daily (BID) for 12 weeks. |
| ABT-494 18 mg BID | EXPERIMENTAL | ABT-494 18 mg twice daily (BID) for 12 weeks. |
| Upadacitinib (Drug) | ACTIVE_COMPARATOR | During the 8-week randomized withdrawal (RW) phase, participants in this arm will receive upadacitinib at the dose that was determined to work best for them (optimal treatment dose, OTD) during the earlier open-label phase of the study (15 mg, 30 mg, or 45 mg OTD). This study is not designed to compare the different dose levels. Therefore, participants receiving any of the three dose levels will be considered as one arm because each participant is receiving their own OTD. |
| Matching Placebo | PLACEBO_COMPARATOR | During the 8-week RW phase, participants assigned to receive placebo will receive placebo tablets that match their OTD selected during the earlier phase of the study. |
| Participants of age group 12 to <18 years receiving dose A | EXPERIMENTAL | Participants of age group 12 to \<18 years administered with upadacitinib dose A (weight dependent) as described in the protocol. |
| Participants of age group 12 to <18 years receiving dose B | EXPERIMENTAL | Participants of age group 12 to \<18 years administered with upadacitinib dose B (weight dependent) as described in the protocol. |
| Participants of age group 6 to <12 years receiving dose A | EXPERIMENTAL | Participants of age group 6 to \<12 years administered with upadacitinib dose A (weight dependent) as described in the protocol. |
| Participants of age group 2 to <6 years receiving dose A | EXPERIMENTAL | Participants of age group 2 to \<6 years administered with upadacitinib dose A (weight dependent) as described in the protocol. |
| Participants of age group 2 to <18 years receiving dose A | EXPERIMENTAL | Participants of age group 2 to \<18 years administered with upadacitinib dose A as described in the protocol. |
| Part 1; Cohort 1 | EXPERIMENTAL | Participants, 6 to \<12 years of age, will receive low dose of upadacitinib. |
| Part 1; Cohort 2 | EXPERIMENTAL | Participants, 6 to \<12 years of age, will receive high dose of upadacitinib. |
| Part 1; Cohort 3 | EXPERIMENTAL | Participants, 2 to \<6 years of age, will receive low dose of upadacitinib. |
| Part 1; Cohort 4 | EXPERIMENTAL | Participants, 2 to \<6 years of age, will receive high dose of upadacitinib. |
| Part 2 | EXPERIMENTAL | Eligible participants who completed Part 1 will receive weight-dependant low dose of upadacitinib. |
| Healthy Volunteers (ABT-494) | EXPERIMENTAL | Multiple dosing of ABT-494 in healthy volunteers |
| Rheumatoid Arthritis Patients | EXPERIMENTAL | Multiple dosing of ABT-494 in patients with rheumatoid arthritis |
| No treatment | PLACEBO_COMPARATOR | Placebo administration in healthy volunteers and patients with rheumatoid arthritis |
| Healthy Volunteers (tofa) | OTHER | Multiple dosing of tofacitinib in healthy volunteers |
| Name | Type | Description |
|---|---|---|
| Upadacitinib Oral Product | DRUG | Upadacitinib oral 45mg once daily. |
| Upadacitinib | DRUG | Oral |
| Placebo | DRUG | Oral |
| Upadacitinib Placebo | DRUG | Oral Tablets |
| Dupilumab | DRUG | Subcutaneous Injection |
| Upadacitinib 15mg Dose | DRUG | Oral tablet |
| Dupilumab 300mg Dose | DRUG | Subcutaneous (SC) injection |
| Upadacitinib 30mg Dose | DRUG | Oral tablet |
| NB-UVB (narrow-band ultraviolet B) Phototherapy | OTHER | NB-UVB phototherapy is a commonly used treatment modality in participants with vitiligo and can be administered in an office setting or at home 2 times per week |
| Tocilizumab | DRUG | Subcutaneous injection or Intravenous infusion |
| Adalimumab | DRUG | Subcutaneous Injection |
| Upadacitinib Matching Placebo | DRUG | Oral Tablets |
| Adalimumab Matching Placebo | DRUG | Subcutaneous Injection |
| Placebo for Upadacitinib | DRUG | Placebo for upadacitinib will be administered as oral tablet |
| Prednisolone | DRUG | Prednisolone will be administered as oral tablet |
| Placebo to dupilumab | DRUG | Placebo administered as a subcutaneous injection |
| Placebo to upadacitinib | DRUG | Tablet |
| Corticosteroid (CS) | DRUG | At Baseline, all participants switched to corticosteroids (CS) provided by the sponsor with the oral prednisone or prednisolone dose at 20, 30, 40, 50, or 60 mg QD. The initial dose of prednisone or prednisolone was at the discretion of the investigator, based on disease severity and comorbid medical conditions, at a minimum of 20 mg QD at Baseline. At Baseline, if a participant was on a dose other than 20, 30, 40, 50, or 60 mg QD, the dose was rounded up or down, as clinically indicated per investigator discretion, to the nearest of these doses. Prednisone or prednisolone was tapered according to a predefined schedule over a 26- or 52-week period. Open-label prednisone or prednisolone was provided until the dose was tapered to 20 mg/day. Subsequently, blinded prednisone or prednisolone was provided for the remaining blinded taper regimen through Week 52. |
| Topical Corticosteroids (TCS) | DRUG | It is administered concomitantly with upadacitinib or placebo. |
| Matching Placebo for Upadacitinib | DRUG | Matching placebo tablets |
| Abatacept | DRUG | IV infusion |
| Placebo for abatacept (0.9% Sodium Chloride Injection or Solution for Infusion) | DRUG | IV infusion |
| Upadacitinib (ABT-494) | DRUG | Upadacitinib (ABT-494) will be administered orally. |
| Methotrexate | DRUG | Capsule; Oral |
| Placebo Upadacitinib | DRUG | Tablet; Oral |
| Placebo Methotrexate | DRUG | Capsule; Oral |
| Placebo to Methotrexate | DRUG | Capsule or Tablet; Oral |
| ABT-494 | DRUG | Tablet: Oral |
| Pneumococcal 13-valent conjugate vaccine (PCV-13) | BIOLOGICAL | Administered by intramuscular injection |
| Tofacitinib | DRUG | Oral administration |
Inclusion Criteria: Adult (≥ 18 - 64 years) male or non-pregnant, non-lactating female patients with: * Confirmed diagnosis of UC, based on conventional clinical, endoscopic, and/or histologic criteria * Admitted to hospital with acute severe flare and refractory to three days of intravenous steroi...
Top 15 of 17 competitors
| Company | Ticker | Trials | Lead Phase | Drugs |
|---|---|---|---|---|
| Sanofi SA Sponsored ADR | SNY | 5 | PHASE3 | Duvakitug, balinatunfib, Brivekimig |
| AbbVie, Inc. | ABBV | 16 | PHASE3 | Upadacitinib, Risankizumab, Lutikizumab, Trosunilimab, ABBV-8736 |
| Eli Lilly and Company | LLY | 7 | PHASE3 | Mirikizumab, Tirzepatide, LY4395089, MORF-057 |
| Takeda Pharmaceutical Co. Ltd. Sponsored ADR | TAK | 15 | PHASE3 | Vedolizumab, Zasocitinib, Darvadstrocel |
| Johnson & Johnson | JNJ | 24 | PHASE3 | Ustekinumab, Guselkumab, JNJ-78934804, Golimumab, Icotrokinra |
| Merck & Co., Inc. | MRK | 2 | PHASE3 | Tulisokibart |
| AstraZeneca PLC | AZN | 2 | PHASE2 | AZD7798 |
| Spyre Therapeutics, Inc | SYRE | 2 | PHASE2 | SPY001, SPY002, SPY003 |
| Disc Medicine, Inc. | IRON | 1 | PHASE2 | DISC-0974 |
| Abivax SA Sponsored ADR | ABVX | 1 | PHASE2 | Obefazimod |
| Shattuck Labs, Inc. | STTK | 1 | PHASE2 | SL-325 |
| AgomAb Therapeutics NV ADR | AGMB | 2 | PHASE2 | Ontunisertib |
| Hoffmann-La Roche | RHHBY | 1 | PHASE2 | Afimkibart |
| Pfizer Inc. | PFE | 1 | PHASE2 | Etrasimod |
| Palisade Bio, Inc. | PALI | 1 | PHASE1 | PALI-2108 |
ABT-494 is an investigational small molecule developed by AbbVie Inc. (ticker ABBV) for inflammatory conditions. It has been studied in Crohn's disease and rheumatoid arthritis. It is also known as upadacitinib. The program has completed Phase 2 trials in Crohn's disease and Phase 1 and Phase 2 trials in rheumatoid arthritis.
ABT-494 has been studied in Crohn's disease, including moderately to severely active cases in adults who inadequately responded to or were intolerant to immunomodulators or anti-TNF therapy. Two completed Phase 2 trials evaluated it in this indication, one for induction of symptomatic and endoscopic remission and one for long-term efficacy, safety, and tolerability with repeated administration.
AbbVie Inc., which trades under the ticker ABBV, is the developer of ABT-494. AbbVie sponsored the clinical trials of the drug in Crohn's disease and rheumatoid arthritis, including the Phase 2 studies NCT02782663 and NCT02365649 in Crohn's disease and NCT01960855 in rheumatoid arthritis.
ABT-494 is in Phase 2 development based on the completed trials in Crohn's disease and rheumatoid arthritis. It is an investigational small molecule and is not described as approved. The Phase 2 studies include NCT02782663 and NCT02365649 in Crohn's disease and NCT01960855 in rheumatoid arthritis.
ABT-494 has been evaluated in completed trials including NCT02782663, a Phase 2 long-term study in Crohn's disease with 107 participants, and NCT02365649, a Phase 2 randomized, double-blind, placebo-controlled induction study in Crohn's disease with 220 participants. NCT01960855 studied it with methotrexate in rheumatoid arthritis, and NCT01741493 was a Phase 1 study.
Yes, ABT-494 is also known as upadacitinib. ABT-494 is the code name used in the clinical trial titles, including the Crohn's disease studies NCT02782663 and NCT02365649 and the rheumatoid arthritis study NCT01960855. Both names refer to the same investigational small molecule developed by AbbVie.