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• W2953272007 abstract "In The Lancet, Josef Smolen and colleagues 1 Smolen JS Pangan AL Emery P et al. Upadacitinib as monotherapy in patients with active rheumatoid arthritis and inadequate response to methotrexate (SELECT-MONOTHERAPY): a randomised, placebo-controlled, double-blind phase 3 study. Lancet. 2019; 393: 2303-2311 Summary Full Text Full Text PDF PubMed Scopus (162) Google Scholar report the results of a double-blind, placebo-controlled trial of upadacitinib, a new oral Janus kinase (JAK) inhibitor, in patients with active rheumatoid arthritis (RA). Interestingly, upadacitinib was evaluated as a monotherapy, without concomitant methotrexate (MTX). Existing recommendations for management of RA 2 Smolen JS Landewé R Bijlsma J et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017; 76: 960-977 Crossref PubMed Scopus (1800) Google Scholar do not include novel disease-modifying antirheumatic drug (DMARD) monotherapy as part of the strategy. Nevertheless, there is growing interest in the use of novel DMARDs (namely, biological DMARDs [bDMARDs], such as tumour necrosis factor-α or interleukin-6 inhibitors, as well as targeted synthetic DMARDs [tsDMARDs], such as oral JAK inhibitors) in RA monotherapy. Several factors might explain this interest: poor tolerability (eg, nausea and fatigue) or contraindications (eg, pregnancy) of conventional synthetic DMARDs (csDMARDs) such as MTX; potential sensitisation to bDMARDs that could be prevented by the use of csDMARDs; 3 Jani M Barton A Warren RB Griffiths CEM Chinoy H The role of DMARDs in reducing the immunogenicity of TNF inhibitors in chronic inflammatory diseases. Rheumatology Oxford. 2014; 53: 213-222 Crossref PubMed Scopus (160) Google Scholar and data from real-life practice that reveal up to 30% of RA patients on monotherapy were treated with bDMARDs. 4 Gabay C Riek M Scherer A Finckh A SCQM collaborating physiciansEffectiveness of biologic DMARDs in monotherapy versus in combination with synthetic DMARDs in rheumatoid arthritis: data from the Swiss Clinical Quality Management Registry. Rheumatology. 2015; 54: 1664-1672 Crossref PubMed Scopus (58) Google Scholar Upadacitinib as monotherapy in patients with active rheumatoid arthritis and inadequate response to methotrexate (SELECT-MONOTHERAPY): a randomised, placebo-controlled, double-blind phase 3 studyUpadacitinib monotherapy showed statistically significant improvements in clinical and functional outcomes versus continuing methotrexate in this methotrexate inadequate-responder population. Safety observations were similar to those in previous upadacitinib rheumatoid arthritis studies. Full-Text PDF" @default.
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• W2953272007 title "Novel DMARD monotherapy in rheumatoid arthritis" @default.
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• W2953272007 doi "https://doi.org/10.1016/s0140-6736(19)30768-8" @default.
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