A Study Comparing Upadacitinib (ABT-494) to Placebo and to Adalimumab in Participants With Psoriatic Arthritis Who Have an Inadequate Response to at Least One Non-Biologic Disease Modifying Anti-Rheumatic Drug (DMARD) (SELECT - PsA 1)
Psoriatic Arthritis
About this trial
This is an interventional treatment trial for Psoriatic Arthritis focused on measuring Arthritis, Psoriasis, Anti-inflammatory, Joint disease, Musculoskeletal disease, Anti-Rheumatic
Eligibility Criteria
Inclusion Criteria:
- Clinical diagnosis of PsA with symptom onset at least 6 months prior to the Screening Visit and fulfillment of the Classification Criteria for PsA (CASPAR) criteria.
- Participant has active disease at Baseline defined as >= 3 tender joints (based on 68 joint counts) and >= 3 swollen joints (based on 66 joint counts) at Screening and Baseline Visits.
Presence of either at Screening:
- >= 1 erosion on x-ray as determined by central imaging review or;
- high-sensitivity C-reactive protein (hs-CRP) > laboratory defined upper limit of normal (ULN).
- Diagnosis of active plaque psoriasis or documented history of plaque psoriasis.
- Participant has had an inadequate response (lack of efficacy after a minimum 12 week duration of therapy) to previous or current treatment with at least 1 non-biologic DMARD at maximally tolerated dose (methotrexate (MTX), sulfasalazine (SSZ), leflunomide (LEF), cyclosporine, apremilast, bucillamin or iguratimod), or participant has an intolerance to or contraindication for DMARDs as defined by the investigator.
Participant who is on current treatment with concomitant non-biologic DMARDs at study entry must be on <= 2 non-biologic DMARDs (except the combination of MTX and leflunomide). The following non-biologic DMARDs are allowed: MTX, sulfasalazine, leflunomide, apremilast, hydroxychloroquine (HCQ) , bucillamine or iguratimod, and have been ongoing for >= 12 weeks and at stable dose for >= 4 weeks prior to the Baseline Visit. No other DMARDs are permitted during the study.
i. Participants who need to discontinue DMARDs prior to the Baseline Visit to comply with this inclusion criterion must follow the procedure specified below or at least five times the mean terminal elimination half-life of a drug:
- >= 8 weeks for LEF if no elimination procedure was followed, or adhere to an elimination procedure (i.e., 11 days with cholestyramine, or 30 days washout with activated charcoal or as per local label);
>= 4 weeks for all others.
Exclusion Criteria:
- Prior exposure to any Janus Kinase (JAK) inhibitor (including but not limited to ruxolitinib, tofacitinib, baricitinib, and filgotinib).
- Current treatment with > 2 non-biologic DMARDs; or use of DMARDs other than methotrexate, sulfasalazine, leflunomide, apremilast, hydroxychloroquine, bucillamine, or iguratimod; or use of methotrexate in combination with leflunomide.
- History of fibromyalgia, any arthritis with onset prior to age 17 years, or current diagnosis of inflammatory joint disease other than PsA (including, but not limited to rheumatoid arthritis, gout, overlap connective tissue diseases, scleroderma, polymyositis, dermatomyositis, systemic lupus erythematosus). Prior history of reactive arthritis or axial spondyloarthritis including ankylosing spondylitis and nonradiographic axial spondyloarthritis is permitted if documentation of change in diagnosis to PsA or additional diagnosis of PsA is made. Prior history of fibromyalgia is permitted if documentation of change in diagnosis to PsA or documentation that the diagnosis of fibromyalgia was made incorrectly.
Sites / Locations
- Rheum Assoc of North Alabama /ID# 163231
- SunValley Arthritis Center, Lt /ID# 161221
- AZ Arthritis and Rheumotology Research, PLLC /ID# 159981
- AZ Arthritis and Rheumotology Research, PLLC /ID# 160033
- AZ Arthritis and Rheumotology Research, PLLC /ID# 160036
- AZ Arthritis & Rheuma Research /ID# 160037
- AZ Arth & Rheum Res /ID# 166381
- Little Rock Diagnostics Clinic /ID# 165161
- Covina Arthritis Clinic /ID# 159891
- St. Joseph Heritage Healthcare /ID# 159980
- C.V. Mehta MD, Med Corporation /ID# 161216
- Care Access Research, Huntingt /ID# 160038
- Kotha and Kotha /ID# 159823
- TriWest Research Associates- La Mesa /ID# 159887
- Arthritis & Osteo Medical Ctr /ID# 166760
- University of California, Los Angeles /ID# 164542
- VA Sacramento Medical Center /ID# 164196
- East Bay Rheumatology Medical /ID# 166382
- Inland Rheum Clin Trials Inc. /ID# 159828
- Medvin Clinical Research /ID# 160034
- Denver Arthritis Clinic /ID# 159873
- Arthritis and Rheum Clin N. CO /ID# 160039
- Colorado Arthritis Associates /ID# 159847
- Stamford Therapeutics Consorti /ID# 165131
- Clinical Res of West FL, Inc. /ID# 159829
- International Medical Research - Daytona /ID# 160040
- Omega Research Maitland, LLC /ID# 164193
- Precision Research Org, LLC /ID# 161287
- LeJenue Research Associates /ID# 170965
- Medallion Clinical Research Institute, LLC /ID# 161228
- Millennium Research /ID# 159822
- Arthritis Center, Inc. /ID# 163465
- Gulf Region Clinical Res Inst /ID# 159851
- BayCare Medical Group /ID# 159792
- W. Broward Rheum Assoc Inc. /ID# 161388
- Clinical Research of West Florida, Inc /ID# 160063
- University of South Florida /ID# 161286
- BayCare Medical Group, Inc. /ID# 159879
- Florida Medical Clinic /ID# 159992
- Institute of Arthritis Researc /ID# 165873
- Advanced Clinical Research /ID# 159894
- Great Lakes Clinical Trials /ID# 163435
- OrthoIllinois /ID# 164546
- Clinical Investigation Specialists - Skokie /ID# 160062
- Deerbrook Medical Associates /ID# 159804
- Graves Gilbert Clinic /ID# 161285
- Four Rivers Clinical Research /ID# 159982
- Ochsner Clinic Foundation-New Orleans /ID# 165672
- Johns Hopkins University /ID# 167665
- Klein & Associates, M.D., P.A. /ID# 164013
- The Center for Rheumatology & Bone Research /ID# 159874
- Tufts Medical Center /ID# 165144
- Mansfield Health Center /ID# 159805
- Clinical Pharmacology Study Gr /ID# 158700
- Univ of Michigan Hospitals /ID# 164014
- Aa Mrc Llc /Id# 159846
- Advanced Rheumatology, PC /ID# 159893
- Beals Institute PC /ID# 163128
- Shores Rheumatology, PC /ID# 159889
- St. Luke's Hospital of Duluth /ID# 165671
- Clayton Medical Associates dba Saint Louis Rheumatology /ID# 159878
- Clinvest Research LLC /ID# 161227
- Glacier View Research Institut /ID# 167023
- Westroads Clinical Research /ID# 159979
- Dartmouth-Hitchcock Medical Center /ID# 161235
- Arthritis and Osteoporosis Associates /ID# 159802
- Atlantic Coast Research /ID# 159799
- Ocean Rheumatology, PA /ID# 163898
- Arthritis and Osteo Assoc /ID# 159994
- Santa Fe Rheumatology /ID# 163783
- NYU Langone Rheum Assoc /ID# 159985
- NYU Langone Medical Center /ID# 163230
- St. Lawrence Health System /ID# 159848
- American Health Research /ID# 164354
- DJL Clinical Research, PLLC /ID# 161390
- M3-Emerging Medical Research, LLC /ID# 161391
- Physicians East, PA /ID# 159872
- Cape Fear Arthritis Care /ID# 161224
- Shanahan Rheuma & Immuno /ID# 159987
- Trinity Health Med Arts Clinic /ID# 159800
- MetroHealth Medical Center /ID# 159888
- The Ohio State University /ID# 159892
- Clinical Research Source, Inc. /ID# 164545
- STAT Research, Inc. /ID# 161392
- Health Research of Oklahoma /ID# 159880
- Altoona Ctr Clinical Res /ID# 159852
- PA Regional Center /ID# 165670
- Articularis Healthcare Group, Inc d/b/a Low Country Rheumatology /ID# 163464
- West Tennessee Research Inst /ID# 159871
- Rheumatology Consultants, PLLC /ID# 159796
- Dr. Ramesh Gupta /ID# 160061
- Accurate Clinical Management /ID# 159905
- Diagnostic Group Integrated He /ID# 159794
- Arth and Osteo Clin Brazo Valley /ID# 163436
- PCCR Solution /ID# 205723
- Adriana Pop-Moody MD Clinic PA /ID# 159984
- Metroplex Clinical Research /ID# 159785
- Rheumatic Disease Clin Res Ctr /ID# 161240
- Rheumatology Clinic of Houston /ID# 161234
- "DMCR-Texas Cent for Drug Dev /ID# 164191
- West Texas Clinical Research /ID# 205722
- P&I Clinical Research /ID# 159826
- SW Rheumatology Res. LLC /ID# 159993
- Trinity Universal Research Association /ID# 205721
- Arthritis & Osteo Ctr of S. TX /ID# 163784
- Arthritis Clinic of Central TX /ID# 164049
- DM Clinical Research /ID# 161735
- Arthritis & Osteoporosis Clinic /ID# 159786
- Arthritis Clinic of N. VA, P.C /ID# 159849
- Ctr for Arth and Rheum Disease /ID# 159830
- Swedish Medical Center /ID# 159890
- Arthritis Northwest, PLLC /ID# 166380
- West Virginia Research Inst /ID# 159791
- Aurora Rheumatology and Immunotherapy Center /ID# 160043
- Centro Medico Privado/Reuma /ID# 159775
- Centro Integral de Medicina Respiratoria (CIMER) /ID# 211237
- Organizacion Medica de Investigacion (OMI) /ID# 160118
- Hospital General de Agudos Ram /ID# 164378
- Psoriahue Med Interdisciplinar /ID# 160506
- Inst. de Rehab. Psicofisica /ID# 165154
- Instituto CAICI /ID# 160119
- Centro Integral de Medicina Re /ID# 160258
- Centro de Enfermedades del Hígado y Aparato Digestivo /ID# 165795
- Emeritus Research Sydney /ID# 166780
- The Queen Elizabeth Hospital /ID# 169333
- Barwon Rheumatology /ID# 166782
- Heidelberg Repatriation Hospital /ID# 167450
- Brest Regional Hospital /ID# 164535
- Healthcare Institution /ID# 164536
- First City Clinical Hospital /ID# 164534
- Reuma clinic /ID# 164243
- University Clinical Centre of the Republic of Srpska /ID# 164503
- University Clinical Hospital Mostar /ID# 165799
- Clinical Center University of Sarajevo /ID# 164502
- Instituto de Ciencias Farmacêuticas /ID# 163274
- CIP - Centro Internacional de Pesquisa /ID# 161821
- CMiP - Centro Mineiro de Pesquisa Ltda - ME /ID# 161819
- EDUMED Educacao em Saude S/S L /ID# 161816
- Instituto de Educação e Pesquisa do Hospital Moinhos de Vento /ID# 161813
- Hospital de Clinicas de Porto Alegre /ID# 161820
- LMK Sevicos Medicos S/S /ID# 161812
- Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto - USP /ID# 163273
- Faculdade de Medicina do ABC /ID# 163491
- CEMEC - Centro Multidisciplinar de Estudos Clínicos do ABC /ID# 161810
- CPCLIN - Centro de Pesquisas Clínicas /ID# 161818
- Department of Rheumatology, Mu /ID# 169606
- Excelsior Medical Center /ID# 169609
- Multiprofile Hospital for Active Treatment - Sofia at Military Medical Academy /ID# 169608
- UMHAT Sv. Ivan Rilski /ID# 202393
- Medical Centre Synexus Sofia /ID# 202394
- Medical Centre Synexus Sofia, branch Stara Zagora /ID# 202524
- Diagnostic Consultative Center /ID# 169607
- Percuro Clinical Research, Ltd /ID# 157823
- Manitoba Clinic /ID# 157829
- Ciads /Id# 157831
- The Waterside Clinic /ID# 157826
- Groupe de Recherche en Maladies Osseuses Inc /ID# 157824
- Ctr. de Recherche Musculo-Sque /ID# 207069
- M y F Estudios Clínicos Ltda. /ID# 168722
- CTR Estudios SpA /ID# 206217
- Centro Inter Estud Clin CIEC /ID# 168725
- Prosalud Ltda. /ID# 169546
- Clinica Dermacross S.A /ID# 168726
- 1st Aff Hosp of Bengbu Medical College /ID# 201021
- Peking University Third Hospital /ID# 201973
- The First Affiliated Hospital of Shantou University Medical College /ID# 203371
- Zhuzhou Central Hospital /ID# 200201
- The First Affiliated Hospital of Baotou Medical College, Inner Monggolia Univers /ID# 171204
- The First People's Hospital of Linyi /ID# 201970
- Huashan Hospital of Fudan University /ID# 202191
- Shanghai Changhai Hospital /ID# 200202
- West China Hospital /ID# 200199
- Ningbo First Hospital /ID# 201874
- The Aff Hosp Inner Mongolia /ID# 207787
- First Affiliated Hospital of Kunming Medical University /ID# 201264
- Affiliated hospital of nantong university /ID# 208234
- The First Affiliated Hospital of Soochow University /ID# 201875
- People's Hospital of Xinjiang /ID# 201592
- Centro de Investigacion en Reumatologia CIREEM /ID# 166030
- Fundacion Centro de Investigac /Id# 168201
- Ctr Int de Reum del Caribe SAS /ID# 164051
- Preventive Care Sas /Id# 163781
- Hospital Pablo Tobon Uribe /ID# 164233
- Poliklinika Repromed /ID# 203555
- Klinicki bolnicki centar Rijeka /ID# 161159
- Medical Center Kuna-Peric /ID# 161160
- Poliklinika Bonifarm /ID# 206662
- Revmatologicka ambulance /ID# 159637
- Revmatologicka ambulance /ID# 159671
- Revmatologie Bruntal, s.r.o /ID# 159636
- Artroscan s.r.o. /ID# 159634
- Medical Plus, s.r.o. /ID# 159635
- Center of Clinical and Basic Research /ID# 163870
- MediTrials /ID# 163706
- East Tallinn Central Hospital /ID# 163790
- Rheumazentrum Ruhrgebiet /ID# 163930
- Immanuel-Krankenhaus /ID# 163931
- University Clinic Carl Gustav /ID# 163926
- Polikilinik fuer Rheumatologie /ID# 163933
- Cent fur Innovative Diagnostik /ID# 163927
- Hamburger Rheuma Forschungszentrum II im MVZ Rheumatologie und Autoimmunmedizin /ID# 204421
- Dr. med. Jochen Walter FA fuer /ID# 168638
- Med. Universitaetsklinik Inner /ID# 163929
- General Hospital of Athens Laiko /ID# 163476
- General Hospital of Athens Laiko /ID# 163478
- University General Hospital Attikon /ID# 163477
- Naval Hospital of Athens /ID# 163486
- University General Hospital of Heraklion PA.G.N.I /ID# 163472
- Reg Gen Univ Hosp Larissa /ID# 163496
- Prince of Wales Hospital /ID# 163506
- Queen Mary Hospital /ID# 162492
- Tuen Mun Hospital /ID# 162493
- Synexus Magyarorszag Kft. - Gyula DRS /ID# 202209
- Qualiclinic Kft. /ID# 163278
- Szabolcs-Szatmar-Bereg Megyei Korhazak & Egyetemi Oktatok.- Klinikai Kutatasi O. /ID# 202584
- Synexus Magyarorszag Kft. - Zalaegerszeg AS /ID# 201884
- Betegapolo Irgalmas Rend - Budai Irgalmasrendi Korhaz /ID# 170719
- Revita Reumatologiai Rendelo /ID# 163277
- Obudai Egeszsegugyi Centrum Kft. /ID# 163279
- Synexus Magyarorszag Kft. /ID# 203012
- Debreceni Egyetem Kenezy Gyula /ID# 163276
- Vital Medical Center Orvosi-es Fogaszati Kozpont /ID# 163275
- St Vincent's University Hosp /ID# 161073
- Croom Orthopaedic Hospital /ID# 164998
- Tel Aviv Sourasky Medical Center /ID# 169845
- The Lady Davis Carmel MC /ID# 170262
- Sheba Medical Center /ID# 202532
- AOU Federico II /ID# 202411
- Azienda Unita Sanitaria Locale/IRCCS c/o Arcispedale Santa Maria Nuova /ID# 161090
- Policlinico Universitario Campus Bio-Medico /ID# 162306
- Ospedali Riuniti Universita /ID# 161085
- Azienda Ospedaliera Universitaria Policlinico "G. Rodolico - San Marco" /Id# 161084
- Nagoya City University Hospital /ID# 162564
- Fukuoka University Hospital /ID# 162086
- Hospital of the University of Occupational and Environmental Health /ID# 161473
- Mie University Hospital /ID# 162080
- National Hospital Organization Osaka Minami Medical Center /ID# 162590
- St.Luke's International Hospital /ID# 162016
- Ajou University Hospital /ID# 163891
- Inha University Hospital /ID# 163890
- M &M Centrs /Id# 161483
- D.Saulites-Kandevicas PP in Cardiology and Rheumatology /ID# 161488
- Clinic ORTO /ID# 161486
- P. Stradins Clinical Univ Hosp /ID# 164442
- VAKK dr. Kildos Clinic /ID# 167257
- Klaipeda University Hospital /ID# 167258
- Public Institution Republican /ID# 165155
- Vilnius University Hospital /ID# 165123
- Hospital Raja Permaisuri Bainun /ID# 161099
- Hospital Tuanku Ja afar /ID# 161096
- CINTRE, Centro de Investigación y Tratamiento Reumatológico SC /ID# 164006
- Instituto Jalisciense de Metabolismo SC /ID# 164005
- Invest y Biomed de Chihuahua /ID# 164007
- Medisch Centrum Leeuwarden /ID# 161575
- Erasmus Medisch Centrum /ID# 161092
- Maasstad Ziekenhuis /ID# 160168
- Waikato Hospital /ID# 166415
- North Shore Hospital /ID# 169409
- Middlemore Hospital /ID# 166414
- Porter Rheumatology Ltd /ID# 200421
- Timaru Rheumatology Studies /ID# 166413
- Helse Forde /ID# 167853
- St. Olavs Hospital HF /ID# 163321
- Synexus Polska Sp. z o.o. /ID# 204506
- NZOZ Nasz Lekarz /ID# 163774
- Salve Medica Sp. z o.o. S.K. /ID# 206300
- Malopolskie Centrum Kliniczne /ID# 163777
- Synexus Polska Sp. z o.o. Oddzial w Gdansku /ID# 206299
- Synexus Polska Sp. z o.o. Oddzial w Gdyni /ID# 207157
- Synexus Polska Sp. z o.o. Oddzial Katowice /ID# 204510
- ETYKA-Osrodek Badan Klinicznyc /ID# 163776
- Centrum Kliniczno-Badawcze /ID# 161830
- Krakowskie Centrum Medyczne /ID# 206302
- Synexus Polska Sp. z o.o. Oddzial w Poznaniu /ID# 207158
- Medycyna Kliniczna /ID# 166288
- Synexus Polska Sp. z.o.o. /ID# 203987
- Reumatika - Centrum Reumatologii NZOZ /ID# 161831
- Instituto Portugues De Reumatologia /ID# 165858
- Centro Hospitalar Lisboa Ocidental, EPE /ID# 165861
- Centro Hospitalar de Vila Nova Gaia/Espinho, EPE /ID# 165862
- Centro Hospitalar Lisboa Norte, EPE /ID# 165860
- Hospital CUF Descobertas /ID# 165866
- Hospital Beatriz Angelo /ID# 165865
- Unidade Local De Saude Do Alto Minho /ID# 165863
- Cruz-Santana, Carolina, PR /ID# 163307
- Ponce Medical School Foundation /ID# 163920
- GCM Medical Group, PSC /ID# 162160
- Family Outpatient clinic#4 LLC /ID# 164530
- LLC Medical Center /ID# 164529
- Kazan State Medical University /ID# 164531
- Moscow S.P.Botkin City Clinica /ID# 164533
- State budgetary institution /ID# 164532
- Institute for Rheumatology /ID# 166217
- Institute for Rheumatology /ID# 166223
- Institute for Rheumatology /ID# 166229
- Institute for Rheumatology /ID# 166231
- Military Medical Academy /ID# 166293
- Singapore General Hospital /ID# 161094
- Tan Tock Seng Hospital /ID# 161095
- MEDMAN s.r.o. /ID# 165892
- Reumatologická ambulancia Reum.hapi s.r.o. /ID# 166486
- Slovak research center Team Member, Thermium s.r.o. /ID# 166489
- Univ Medical Ctr Ljubljana /ID# 164212
- University Medical Ctr Maribor /ID# 169260
- General Hospital Murska Sobota /ID# 164211
- Greenacres Hospital /ID# 164190
- Wits Clinical Research Site /ID# 163919
- University of Pretoria /ID# 163852
- Jakaranda Hospital /ID# 164242
- Arthritis Clinical Research Tr /ID# 163855
- Winelands Medical Research Ctr /ID# 163853
- Hospital Universitario A Coruña - CHUAC /ID# 161129
- Hospital Campus de la Salud /ID# 170760
- Hospital Universitario Ramon y Cajal /ID# 161130
- Hospital Universitario 12 de Octubre /ID# 163198
- Kantonsspital St. Gallen /ID# 158131
- HFR Fribourg - Hopital Canton /ID# 162090
- China Medical University Hosp /ID# 159402
- Chung Shan Medical University /ID# 159403
- National Taiwan University Hospital /ID# 160878
- Taipei Veterans General Hosp /ID# 166222
- Linkou Chang Gung Memorial Ho /ID# 166221
- Cukurova Universitesi Tip Fakultesi /ID# 162516
- Hacettepe Universitesi Tip Fak /ID# 162518
- Bakirkoy Dr. Sadi Konuk Training & Research Hospital /ID# 162517
- Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi /ID# 163383
- Necmettin Erbakan Universitesi /ID# 163382
- Sakarya Universitesi Egitim /ID# 163397
- State Institution L. T. Malaya Therapy National Institution of NAMS of Ukraine /ID# 164170
- Lviv Regional Clinical Hospita /ID# 164178
- Kharkiv Regional Council Regional Clinical Hospital /ID# 210189
- NSC Strazhesko Ist Cardiology /ID# 164043
- Med Ctr of Private High Ed Ins /ID# 208527
- Medical Center of LLC Medbud-Clinic /ID# 208528
- Kyiv Railway Clinical Hosp No.2 /ID# 208951
- LLC Revmocentr /ID# 164177
- MNI KRC Kyiv Regional Clinical Hospital /ID# 210188
- Odessa National Medical Univ /ID# 164244
- Vinnytsia Regional Clinical Hospital n.a. M.I.Pyrogov /ID# 164245
- Whipps Cross Univ Hospital /ID# 161055
- Guy's and St Thomas' NHS Found /ID# 161065
- Christchurch Hospital /ID# 162702
- UH Coventry & Warwickshire /ID# 162701
- Glasgow Royal Infirmary /ID# 162703
- Luton & Dunstable University Hospital /ID# 162704
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Experimental
Experimental
Active Comparator
Placebo Comparator
Placebo Comparator
Upadacitinib 15 mg
Upadacitinib 30 mg
Adalimumab
Placebo / Upadacitinib 15 mg
Placebo / Upadacitinib 30 mg
Period 1: Participants receive upadacitinib 15 mg orally once a day (QD) and matching placebo to adalimumab by subcutaneous injection every other week (EOW) for 56 weeks. Period 2: Participants will continue to receive upadacitinib 15 mg once daily.
Period 1: Participants receive upadacitinib 30 mg orally once a day and matching placebo to adalimumab by subcutaneous injection every other week for 56 weeks. Period 2: Participants will continue to receive upadacitinib 30 mg once daily.
Period 1: Participants receive adalimumab 40 mg by subcutaneous injection every other week and matching placebo to upadacitinib orally QD for 56 weeks. Period 2: Participants continue to receive adalimumab 40 mg every other week.
Period 1: Participants receive matching placebo to upadacitinib orally once a day for 24 weeks then upadacitinib 15 mg once daily for 32 weeks, and matching placebo to adalimumab by subcutaneous injection EOW for the entire 56 weeks. Period 2: Participants will continue to receive upadacitinib 15 mg once daily.
Period 1: Participants receive matching placebo to upadacitinib orally once a day for 24 weeks then upadacitinib 30 mg once daily for 32 weeks, and matching placebo to adalimumab by subcutaneous injection EOW for the entire 56 weeks. Period 2: Participants will continue to receive upadacitinib 30 mg once daily.