An Open-label Extension Study Evaluating the Safety and Efficacy of Upadacitinib (ABT-494) in Adults With Rheumatoid Arthritis (BALANCE-EXTEND)
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ClinicalTrials.gov Identifier: NCT02049138 |
Recruitment Status :
Completed
First Posted : January 30, 2014
Results First Posted : July 12, 2022
Last Update Posted : July 12, 2022
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Study Type | Interventional |
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Study Design | Allocation: N/A; Intervention Model: Single Group Assignment; Masking: None (Open Label); Primary Purpose: Treatment |
Condition |
Rheumatoid Arthritis |
Interventions |
Drug: Upadacitinib Biological: Pneumococcal 13-valent conjugate vaccine (PCV-13) |
Enrollment | 493 |
Recruitment Details |
Participants must have completed a preceding rheumatoid arthritis (RA) upadacitinib randomized controlled trial (RCT), Study M13-550 (NCT01960855) or Study M13-537 (NCT02066389) to be enrolled in this long-term extension study. Participants were enrolled at 113 study sites located in 17 countries (Belgium, Bulgaria, Chile, Czechia, Hungary, Israel, Latvia, Mexico, New Zealand, Poland, Russian Federation, Slovakia, South Africa, Spain, United Kingdom, Ukraine, and United States/Puerto Rico). |
Pre-assignment Details |
Participants were assigned to upadacitinib 6 mg twice-daily up to 30 days following the Last Visit (Week 12) of the preceding RCT. Participants may have been up-titrated to 12 mg BID and subsequently down-titrated per protocol-specified criteria. Efficacy results are reported by treatment sequence for each participant. Adverse event data are reported according to treatment received at the time of the event. Participants may have enrolled in a vaccine substudy during the main study. |
Arm/Group Title | Upadacitinib Never Titrated | Upadacitinib Titrated Up and Not Down | Upadacitinib Titrated Up and Down |
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Participants received treatment with upadacitinib for up to 312 weeks. The starting dose was 6 mg twice a day (BID). From January 2017 participants were transitioned to a once-daily (QD) dose of 15 mg upadacitinib and remained on this dose throughout the study. A subset of participants who opted-in to the vaccine substudy received a single-dose of 0.5 mL intramuscular injection of pneumococcal 13-valent conjugate vaccine (PCV-13). |
Participants received treatment with upadacitinib for up to 312 weeks. The starting dose was 6 mg BID. Participants who did not achieve protocol-specified improvement criteria at Week 6 or at any visits thereafter were up-titrated to upadacitinib 12 mg BID. From January 2017 participants were transitioned to a once-daily dose of 30 mg upadacitinib and remained on this dose throughout the study. A subset of participants who opted-in to the vaccine substudy received a single-dose of 0.5 mL intramuscular injection of pneumococcal 13-valent conjugate vaccine (PCV-13). |
Participants received treatment with upadacitinib for up to 312 weeks. The starting dose was 6 mg BID. Participants who did not achieve protocol-specified improvement criteria at Week 6 or at any visits thereafter were up-titrated to upadacitinib 12 mg BID. From January 2017 participants were transitioned to once-daily dose of 30 mg upadacitinib. The upadacitinib dose was decreased back to 6 mg BID (or 15 mg QD from January 2017) per Investigator's judgment or safety and/or tolerability concerns. A subset of participants who opted-in to the vaccine substudy received a single-dose of 0.5 mL intramuscular injection of pneumococcal 13-valent conjugate vaccine (PCV-13). |
Period Title: Overall Study | |||
Started | 306 | 149 | 38 |
Enrolled in Vaccine Sub-study | 76 | 24 | 11 |
Completed | 142 | 51 | 30 |
Not Completed | 164 | 98 | 8 |
Reason Not Completed | |||
Adverse Event | 46 | 25 | 1 |
Withdrawal by Subject | 57 | 21 | 5 |
Lost to Follow-up | 18 | 5 | 1 |
Lack of Efficacy | 10 | 26 | 1 |
Non-Compliance | 15 | 6 | 0 |
Required Alternative / Prohibited Therapy | 1 | 1 | 0 |
Coronavirus Disease-2019 (COVID-19) Infection | 1 | 0 | 0 |
COVID-19 Logistical Restrictions | 1 | 0 | 0 |
Other | 15 | 13 | 0 |
Missing | 0 | 1 | 0 |
Arm/Group Title | Upadacitinib Never Titrated | Upadacitinib Titrated Up and Not Down | Upadacitinib Titrated Up and Down | Total | |
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Participants received treatment with upadacitinib for up to 312 weeks. The starting dose was 6 mg twice a day (BID). From January 2017 participants were transitioned to once-daily (QD) dose of 15 mg upadacitinib. | Participants received treatment with upadacitinib for up to 312 weeks. The starting dose was 6 mg BID. Participants who did not achieve protocol-specified improvement criteria at Week 6 or at any visits thereafter were up-titrated to upadacitinib 12 mg BID. From January 2017 participants were transitioned to once-daily dose of 30 mg upadacitinib. | Participants received treatment with upadacitinib for up to 312 weeks. The starting dose was 6 mg BID. Participants who did not achieve protocol-specified improvement criteria at Week 6 or at any visits thereafter were up-titrated to upadacitinib 12 mg BID. From January 2017 participants were transitioned to once-daily dose of 30 mg upadacitinib. The upadacitinib dose was decreased back to 6 mg BID (or 15 mg QD from January 2017) per Investigator's judgment or safety and/or tolerability concerns. | Total of all reporting groups | |
Overall Number of Baseline Participants | 306 | 149 | 38 | 493 | |
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The open-label treated population consisted of all participants who had received at least one dose of open-label study medication.
Baseline data are from the Baseline of the preceding RCT study (M13-550 or M13-537).
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Age, Continuous
Mean (Standard Deviation) Unit of measure: Years |
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Number Analyzed | 306 participants | 149 participants | 38 participants | 493 participants | |
55.8 (12.62) | 56.0 (12.56) | 53.7 (8.54) | 55.7 (12.33) | ||
Age, Customized
Measure Type: Count of Participants Unit of measure: Participants |
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Number Analyzed | 306 participants | 149 participants | 38 participants | 493 participants | |
< 45 years |
56 18.3%
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30 20.1%
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5 13.2%
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91 18.5%
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45 - < 65 years |
174 56.9%
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76 51.0%
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28 73.7%
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278 56.4%
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≥ 65 years |
76 24.8%
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43 28.9%
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5 13.2%
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124 25.2%
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Sex: Female, Male
Measure Type: Count of Participants Unit of measure: Participants |
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Number Analyzed | 306 participants | 149 participants | 38 participants | 493 participants | |
Female |
246 80.4%
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117 78.5%
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29 76.3%
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392 79.5%
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Male |
60 19.6%
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32 21.5%
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9 23.7%
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101 20.5%
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Ethnicity (NIH/OMB)
Measure Type: Count of Participants Unit of measure: Participants |
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Number Analyzed | 306 participants | 149 participants | 38 participants | 493 participants | |
Hispanic or Latino |
76 24.8%
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40 26.8%
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7 18.4%
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123 24.9%
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Not Hispanic or Latino |
230 75.2%
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109 73.2%
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31 81.6%
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370 75.1%
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Unknown or Not Reported |
0 0.0%
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0 0.0%
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0 0.0%
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0 0.0%
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Race/Ethnicity, Customized
Measure Type: Count of Participants Unit of measure: Participants |
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Number Analyzed | 306 participants | 149 participants | 38 participants | 493 participants | |
White |
293 95.8%
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132 88.6%
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37 97.4%
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462 93.7%
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Black or African American |
9 2.9%
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12 8.1%
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1 2.6%
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22 4.5%
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Asian |
1 0.3%
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2 1.3%
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0 0.0%
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3 0.6%
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American Indian or Alaska Native |
0 0.0%
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0 0.0%
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0 0.0%
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0 0.0%
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Native Hawaiian or Other Pacific Islander |
1 0.3%
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0 0.0%
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0 0.0%
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1 0.2%
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Multiple |
2 0.7%
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3 2.0%
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0 0.0%
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5 1.0%
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Region
Measure Type: Count of Participants Unit of measure: Participants |
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Number Analyzed | 306 participants | 149 participants | 38 participants | 493 participants | |
Western Europe |
27 8.8%
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13 8.7%
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5 13.2%
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45 9.1%
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Eastern Europe |
144 47.1%
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46 30.9%
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19 50.0%
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209 42.4%
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North America |
90 29.4%
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78 52.3%
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10 26.3%
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178 36.1%
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South/Central America |
42 13.7%
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5 3.4%
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3 7.9%
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50 10.1%
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Other |
3 1.0%
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7 4.7%
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1 2.6%
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11 2.2%
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Duration of RA
Mean (Standard Deviation) Unit of measure: Years |
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Number Analyzed | 306 participants | 149 participants | 38 participants | 493 participants | |
9.34 (8.73) | 9.61 (8.36) | 7.66 (6.54) | 9.29 (8.47) | ||
Tender Joint Count
[1] Mean (Standard Deviation) Unit of measure: Joints |
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Number Analyzed | 306 participants | 149 participants | 38 participants | 493 participants | |
25.8 (14.49) | 30.4 (15.90) | 31.3 (15.67) | 27.6 (15.17) | ||
[1]
Measure Description: A total of 68 joints were assessed for the presence or absence of tenderness.
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Swollen Joint Count
[1] Mean (Standard Deviation) Unit of measure: Joints |
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Number Analyzed | 306 participants | 149 participants | 38 participants | 493 participants | |
16.7 (10.45) | 18.8 (12.03) | 19.3 (9.53) | 17.5 (10.92) | ||
[1]
Measure Description: A total of 66 joints were assessed for the presence or absence of swelling.
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Physician's Global Assessment of Disease Activity
[1] [2] Mean (Standard Deviation) Unit of measure: Score on a scale |
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Number Analyzed | 298 participants | 147 participants | 38 participants | 483 participants | |
64.4 (15.82) | 65.6 (15.41) | 65.0 (15.41) | 64.8 (15.64) | ||
[1]
Measure Description: The physician rated the participant's current global RA disease activity (independently from the participant's assessment) on a visual analog scale (VAS) from 0 to 100 mm, where 0 mm indicates very low disease activity and 100 mm indicates very high disease activity.
[2]
Measure Analysis Population Description: Participants with available data
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Patient's Global Assessment of Disease Activity
[1] [2] Mean (Standard Deviation) Unit of measure: Score on a scale |
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Number Analyzed | 305 participants | 146 participants | 37 participants | 488 participants | |
62.4 (20.78) | 67.4 (20.52) | 66.5 (16.48) | 64.2 (20.51) | ||
[1]
Measure Description: The participant was asked to rate their current RA disease activity over the past 24 hours on a 100 mm VAS, where 0 mm indicates very low disease activity and 100 mm indicates very high disease activity.
[2]
Measure Analysis Population Description: Participants with available data
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Patient's Global Assessment of Pain
[1] [2] Mean (Standard Deviation) Unit of measure: Score on a scale |
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Number Analyzed | 305 participants | 146 participants | 37 participants | 488 participants | |
63.8 (19.73) | 67.2 (19.64) | 66.5 (13.13) | 65.0 (19.32) | ||
[1]
Measure Description: Participants were asked to indicate the severity of their arthritis pain within the previous week on a visual analog scale from 0 to 100 mm. A score of 0 mm indicates "no pain" and a score of 100 mm indicates "worst possible pain."
[2]
Measure Analysis Population Description: Participants with available data
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Health Assessment Questionnaire - Disability Index (HAQ-DI)
[1] [2] Mean (Standard Deviation) Unit of measure: Score on a scale |
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Number Analyzed | 304 participants | 146 participants | 37 participants | 487 participants | |
1.4811 (0.6848) | 1.6036 (0.6215) | 1.5304 (0.4969) | 1.5216 (0.6550) | ||
[1]
Measure Description: The Health Assessment Questionnaire - Disability Index is a patient-reported questionnaire that measures the degree of difficulty a person has in accomplishing tasks in 8 functional areas (dressing, arising, eating, walking, hygiene, reaching, gripping, and errands and chores) over the past week. Participants assessed their ability to do each task on a scale from 0 (without any difficulty) to 3 (unable to do). Scores were averaged to provide an overall score ranging from 0 to 3, where 0 represents no disability and 3 represents very severe, high-dependency disability.
[2]
Measure Analysis Population Description: Participants with available data
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High-sensitivity reactive Protein (hsCRP)
Mean (Standard Deviation) Unit of measure: mg/L |
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Number Analyzed | 306 participants | 149 participants | 38 participants | 493 participants | |
12.8968 (17.8329) | 14.9212 (20.1890) | 17.1232 (28.1184) | 13.8344 (19.5179) |