Fleischmann RM, Genovese MC, Enejosa JV, et al. - Through the SELECT-COMPARE, a randomized double-blind study, the researchers reported 48-week safety and efficiency of upadacitinib or adalimumab plus methotrexate in patients with rheumatoid arthritis who stayed on their original medication or were retained to the alternative medication for an insufficient response. From weeks 26 to 48, responses by the randomized group including low disease activity, clinical remission, and improvements in pain and function remained higher for upadacitinib vs adalimumab and radiographical progression prevailed to be lower for upadacitinib vs placebo (linear extrapolation), constant with responses through week 26. A higher proportion of individuals rescued to upadacitinib from adalimumab achieved Clinical Disease Activity Index ≤ 10 at 6 months following switch vs individuals rescued from upadacitinib to adalimumab, although, both switch groups responded. Safety at week 48 was relative to week 26. In conclusion, upadacitinib + methotrexate (MTX) exhibited better clinical and functional responses in comparison with adalimumab + MTX and maintained inhibition of structural damage vs placebo + MTX through week 48. Moreover, following switching to the alternative medication without washout, individuals with an inadequate response to adalimumab or upadacitinib safely accomplished clinically significant responses.