A Study Comparing Upadacitinib (ABT-494) to Placebo and to Adalimumab in Adults With Rheumatoid Arthritis Who Are on a Stable Dose of Methotrexate and Who Have an Inadequate Response to Methotrexate (SELECT-COMPARE)
Rheumatoid Arthritis
About this trial
This is an interventional treatment trial for Rheumatoid Arthritis focused on measuring Musculoskeletal disease, Arthritis, Joint disease, Anti-inflammatory agents, Antirheumatic agents
Eligibility Criteria
Inclusion Criteria:
- Adult male or female, at least 18 years old.
- Diagnosis of RA for greater than or equal to 3 months.
- Subjects must have been on oral or parenteral methotrexate (MTX) therapy greater than or equal to 3 months and on a stable prescription of greater than or equal to 15 to 25 mg/week (or greater than or equal to 10 mg/week in subjects intolerant of MTX at doses greater than or equal to 12.5 mg/week) for at least 4 weeks prior to the first dose of study drug. In addition all subjects should take a dietary supplement of folic acid or folinic acid throughout the study participation.
- Meets the following minimum disease activity criteria: greater than or equal to 6 swollen joints (based on 66 joint counts) and greater than or equal to 6 tender joints (based on 68 joint counts) at Screening and Baseline Visits.
- At least one of the following at Screening: greater than or equal to 3 bone erosions on x-ray OR greater than or equal to 1 bone erosion and a positive rheumatoid factor OR greater than or equal to 1 bone erosion and a positive anti-cyclic citrullinated peptide autoantibodies.
- Subjects with prior exposure to only one biological disease-modifying anti-rheumatic drugs (bDMARD) (except adalimumab) may be enrolled (up to 20% of total study population) if they have documented evidence of intolerance to the bDMARD or limited exposure (less than 3 months), but required washout periods need to be satisfied.
- Except for MTX, subject must have discontinued all conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs).
Exclusion Criteria:
- Prior exposure to any Janus kinase (JAK) inhibitor (including but not limited to tofacitinib, baricitinib, and filgotinib).
- Subjects who have been exposed to adalimumab or who are considered inadequate responders to bDMARD therapy as determined by the Investigator.
- History of inflammatory joint disease other than RA. History of secondary Sjogren's Syndrome is permitted.
Sites / Locations
- Achieve Clinical Research, LLC /ID# 143136
- AZ Arthritis and Rheum Assoc /ID# 143130
- SunValley Arthritis Center, Lt /ID# 143123
- Elite Clinical Studies, LLC /ID# 144881
- AZ Arthritis and Rheum Researc /ID# 143080
- AZ Arthritis and Rheum Researc /ID# 143121
- AZ Arthritis & Rheuma Research /ID# 143131
- Arizona Research Center, Inc. /ID# 144877
- AZ Arthritis & Rheum Research /ID# 156093
- University of Arizona Cancer Center - North Campus /ID# 143114
- Osteoporosis Medical Center /ID# 153935
- T. Joseph Raoof, MD, Inc. /ID# 144884
- Rheumatology Ctr of San Diego /ID# 153747
- C.V. Mehta MD, Med Corporation /ID# 143116
- Allergy and Rheum Med Clin /ID# 146083
- Kotha and Kotha /ID# 161046
- TriWest Research Associates- La Mesa /ID# 143115
- Valerius Med Grp & Res Ctr /ID# 143120
- Discovery MM Services, Inc /ID# 163504
- Desert Medical Advances /ID# 143097
- Sierra Rheumatology /ID# 155672
- Robin K. Dore MD, Inc /ID# 143090
- Medvin Clinical Research /ID# 148362
- Arthritis Assoc & Osteo Ctr /ID# 143122
- Arthritis and Rheum Clin N. CO /ID# 156094
- AARDS Research, Inc. /ID# 154190
- ZASA Clinical Research /ID# 143134
- Clinical Res of West FL, Inc. /ID# 143112
- International Medical Research /ID# 143132
- Precision Research Org, LLC /ID# 143092
- Lakes Research, LLC /ID# 145630
- FL Med Ctr and Research, Inc. /ID# 143081
- Ctr Arthritis & Rheumatic Dise /ID# 143135
- Advanced Clin Res of Orlando /ID# 154617
- Rheum Assoc of Central FL /ID# 145632
- Omega Research Consultants /ID# 145635
- HMD Research LLC /ID# 163292
- Arthritis Research of Florida /ID# 143125
- Arthritis Center, Inc. /ID# 145647
- St. Anthony Comprehsve Res Ins /ID# 143095
- Clinical Research West FL /ID# 148358
- SW FL Clin Res Ctr, Tampa, FL /ID# 143117
- BayCare Medical Group, Inc. /ID# 143085
- Lovelace Scientific Resources /ID# 143106
- Arthritis and Rheumatology /ID# 155668
- Arthritis Center of North GA /ID# 155258
- North Georgia Rheumatology Grp /ID# 147170
- Advanced Clinical Research /ID# 153090
- Great Lakes Clinical Trials /ID# 148357
- Arthritis Treatment Center /ID# 155260
- The Center for Rheumatology & /ID# 151356
- Clinical Pharmacology Study Gr /ID# 143082
- Advanced Rheumatology, PC /ID# 143118
- Shores Rheumatology, PC /ID# 162977
- St. Luke's Hospital /ID# 156750
- North Mississippi Med Clinics /ID# 145636
- Physician Res. Collaboration /ID# 143087
- Quality Clinical Research Inc. /ID# 156394
- Atlantic Coast Research /ID# 148355
- Ocean Rheumatology, PA /ID# 143111
- Arthritis Rheumatic Back Disorder /ID# 143102
- Albuquerque Clinical Trials, Inc /ID# 143083
- Arthritis and Osteo Assoc /ID# 143127
- St. Lawrence Health System /ID# 161619
- Joint & Muscle Research Instit /ID# 143119
- DJL Clinical Research, PLLC /ID# 143101
- EmergeOrtho, P.A. /ID# 143100
- Cape Fear Arthritis Care /ID# 148361
- Coastal Carolina Health Care /ID# 148359
- Shanahan Rheuma & Immuno /ID# 145643
- Clinical Research Solutions, LLC /ID# 154619
- Arthritis Assoc of NW Ohio /ID# 143094
- Healthcare Research Consultant /ID# 143129
- Altoona Ctr Clinical Res /ID# 143110
- Clinical Research Ctr Reading /ID# 143133
- Columbia Arthritis Center /ID# 153730
- Innovative Clinical Research /ID# 145637
- Articularis Healthcare Group, Inc d/b/a Low Country Rheumatology /ID# 143091
- Arthritis Associates, PLLC /ID# 155490
- Rheumatology Consultants, PLLC /ID# 153731
- Dr. Ramesh Gupta /ID# 143099
- Austin Regional Clinic /ID# 143084
- Diagnostic Group Integrated He /ID# 148356
- Arthritis Care and Diagnostic /ID# 150677
- Metroplex Clinical Research /ID# 145631
- Doctor's Hosp at Renaissance /ID# 154616
- MedResearch Inc. /ID# 154618
- Accurate Clinical Management /ID# 145644
- Accurate Clinical Research /ID# 145645
- Rheumatology Clinic of Houston /ID# 150921
- Houston Institute for Clin Res /ID# 144879
- Pioneer Research Solutions, Inc. /ID# 145640
- Arthritis Consultants, P.A. /ID# 144880
- Arthritis & Osteoporosis Assoc /ID# 147364
- P&I Clinical Research /ID# 161625
- SW Rheumatology Res. LLC /ID# 143126
- Discovery MM Services, Inc. /ID# 162578
- Discovery MM Services, Inc. /ID# 163183
- Discovery MM Services, Inc. /ID# 163184
- Sun Research Institute /ID# 159539
- Accurate Clinical Management /ID# 143089
- Arthritis & Osteo Ctr of S. TX /ID# 143103
- DM Clinical Research /ID# 151357
- Arthritis Clinic of N. VA, P.C /ID# 143109
- Ctr for Arth and Rheum Disease /ID# 143113
- Arthritis Northwest, PLLC /ID# 143088
- The Vancouver Clinic, INC. PS /ID# 143107
- West Virginia Research Inst /ID# 153088
- Rheumatology and Immunotherapy Center /ID# 145646
- Aprillus Asistencia e Investig /ID# 148406
- Mautalen Salud e Investigacion /ID# 142843
- Fundacion Sanatorio Guemes /ID# 148405
- Consultorio Reumatologic Pampa /ID# 144853
- Cemic /Id# 148404
- Org Medica de Investigacion /ID# 144855
- Inst. Rheumatologic Strusberg /ID# 145601
- Consultora Integral de Salud S /ID# 144856
- Instituto CAICI /ID# 144854
- Cordis S.A. /Id# 152622
- Iari /Id# 151293
- Centro Integral de Reumatologi /ID# 142845
- Centro Medico Privado/Reuma /ID# 142842
- Centro de Enfermedades /ID# 153542
- Royal Prince Alfred Hospital /ID# 144857
- Emeritus Research /ID# 142848
- LKH-Univ. Klinikum Graz /ID# 142851
- First City Clinical Hospital /ID# 158011
- Cliniques Universitaires Saint Luc /ID# 142858
- Rhumaconsult SPRL /ID# 142860
- CHU de Liege /ID# 148401
- UZ Gent /ID# 142859
- CHU Ambroise Pare /ID# 152953
- University Clinical Centre of the Republic of Srpska /ID# 142862
- University Clinical Centre of the Republic of Srpska /ID# 142863
- Clinical Center University of Sarajevo /ID# 142865
- CIP - Centro Internacional de Pesquisa /ID# 142872
- Hc Ufmg /Id# 142868
- Ceti - Centro de Estudos Em Terapias Inovadoras Ltda /Id# 142871
- Hospital de Clinicas de Porto Alegre /ID# 142870
- LMK Sevicos Medicos S/S /ID# 142869
- CEPIC - Centro Paulista de Investigação Clínica e Serviços Médicos Ltda /ID# 142867
- CCBR Brasil /ID# 150918
- MHAT Trimontsium /ID# 142874
- UMHAT Pulmed OOD /ID# 142877
- MHAT Kaspela /ID# 142873
- Diagnostic Consultative Center /ID# 142875
- UMHAT Sv. Ivan Rilski /ID# 142876
- Manitoba Clinic /ID# 161434
- Ciads /Id# 142880
- St. Clare's Mercy Hospital /ID# 142879
- Adachi Medicine Prof. Corp /ID# 154205
- CA Ctr for Clin Trials CCCT /ID# 157379
- Groupe de Recherche en Maladies Osseuses /ID# 142878
- Ctr de Inv Clinica del Sur /ID# 142888
- Reg. Clinical Hosptial Concepcion /ID# 151271
- Corp de Beneficencia Osorno /ID# 147941
- Someal /Id# 144704
- Quantum Research LTDA. /ID# 142893
- Quantum Research Stgo. /ID# 157933
- Soc. de Prestaciones medicas y Paramedicas Goecke /ID# 142890
- Clinica DermaCross /ID# 142892
- Investigaciones Medicas SSMSO /ID# 151686
- Centro Inter Estud Clin CIEC /ID# 144777
- Centro Medico de Reumatologia /ID# 148402
- Cinvec /Id# 144705
- Centro de Investigacion en Reumatologia y Especialidades Medicas- CIREEM SAS /ID# 142898
- Ctr Int de Reum del Caribe SAS /ID# 142894
- Fund Inst de Reum F. Chalem /ID# 149847
- Riesgo de Fractura S.A - CAYRE /ID# 142896
- Medicity S.A.S. /ID# 144860
- Centro Integral de Reumatologi /ID# 142897
- Klinicki bolnicki centar Rijeka /ID# 160232
- Klinicki bolnicki centar Split /ID# 152530
- Clinical Hospital Dubrava /ID# 142900
- Medical Center Kuna-Peric /ID# 142901
- Poliklinika Bonifarm /ID# 142899
- L.K.N. Arthrocentrum, s.r.o /ID# 145961
- CTCenter MaVe, s.r.o. /ID# 142905
- Revmatologicky ustav Praha /ID# 142904
- Nuselská poliklinika, Revmatologie /ID# 144862
- Revmatologická ambulance /ID# 145963
- Thomayerova nemocnice /ID# 145962
- REVMACLINIC s.r.o. /ID# 142906
- Revmatologie Bruntal, s.r.o /ID# 142903
- Revmatologicka a interni ambul /ID# 142907
- Revmatologie MUDr. Klara Sirov /ID# 142908
- Arthromed, s.r.o. /ID# 144706
- Aarhus University Hospital /ID# 158838
- Regionhospital Silkeborg /ID# 142914
- Center of Clinical and Basic Research /ID# 142922
- MediTrials /ID# 151870
- Paernu Hospital /ID# 142921
- East Tallinn Central Hospital /ID# 142923
- North Estonian Medical Centre /ID# 145454
- Hopital Universitaire Purpan /ID# 144707
- CHRU Lille - Hôpital Claude Huriez /ID# 151312
- Hopital Saint Eloi /ID# 142925
- CHU Bordeaux-Hopital Pellegrin /ID# 145618
- Hopital de la Cote de Nacre /ID# 145616
- CHU Gabriel Montpied /ID# 145619
- Hopital de la Conception /ID# 142926
- Hopital Pitie Salpetriere /ID# 145605
- CHU de Rennes - Hospital Sud /ID# 151957
- CHU Strasbourg Hautepierre Hos /ID# 144708
- Rheumazentrum Ruhrgebiet /ID# 145620
- Uniklinik Koln /ID# 145964
- Praxis Walter, Rendsburg /ID# 142932
- Med Versorgungszentrum AGILOME /ID# 154975
- Rheumaforschungszentrum II /ID# 142930
- LMU Klinikum der Universität München /ID# 142931
- General Hospital of Athens Laiko /ID# 142934
- University General Hospital Attikon /ID# 142933
- General Hospital of Athens Ippokratio /ID# 142935
- Queen Mary Hospital /ID# 142938
- Tuen Mun Hospital /ID# 142939
- CRU Hungary Egeszsegugyi és Szolgaltato Kft. /ID# 142951
- Qualiclinic Kft. /ID# 142953
- Markusovszky Egyetemi Oktatókórház /ID# 145621
- Vital Medical Center Orvosi es /ID# 145950
- Budai Irgalmasrendi Korhaz /ID# 142952
- Revita Reumatologiai Rendelo /ID# 142950
- Synexus Magyarorszag Kft. /ID# 153061
- Debreceni Egyetem Kenezy Gyula Egyetemi Korhaz /ID# 142948
- Hevizgyogyfurdo es Szent Andra /ID# 142949
- Kiskunhalasi Semmelweis Korhaz /ID# 151944
- Pest Megyei Flor Ferenc Korhaz /ID# 142954
- St Vincent's University Hosp /ID# 142957
- Tel Aviv Sourasky Medical Ctr /ID# 144709
- Rambam Health Care Campus /ID# 152050
- Bnai Zion Medical Center /ID# 151958
- The Lady Davis Carmel MC /ID# 142960
- Sheba Medical Center /ID# 145965
- Istituto Clinico Humanitas /ID# 147528
- AOU Citta della Salute Scienza /ID# 150070
- Azienda Ospedaliera Luigi Sacc /ID# 142966
- A.O.U.I. di Verona Policlinico /ID# 142963
- JSC Nat Scientific Med Res Ctr /ID# 142971
- Karaganda State Medical Univ /ID# 153433
- Semey State Medical University /ID# 152659
- Regional Clinical Hospital /ID# 147168
- Kyungpook National Univ Hosp /ID# 162073
- Chungnam National University Hospital /ID# 142977
- Inha University Hospital /ID# 150886
- Chonnam National University Hospital /ID# 142975
- Hanyang University Seoul Hospi /ID# 142979
- Cath Univ Seoul St Mary's Hosp /ID# 142976
- Daegu Catholic University Med /ID# 142973
- Seoul National University Hospital /ID# 142978
- Asan Medical Center /ID# 142974
- LTD M+M Centers /ID# 142984
- Daugavpils Regional Hospital /ID# 142982
- D.Saulites-Kandevicas PP /ID# 142985
- Clinic ORTO /ID# 142983
- Riga East Clinical Univ Hosp /ID# 142981
- Hosp Lithuanian Univ Health Sc /ID# 142986
- Vilnius University Hospital /ID# 142987
- Hospital Raja Perempuan Zainab II /ID# 157862
- Hospital Selayang /ID# 156756
- Hospital Umum Sarawak /ID# 142990
- Hospital Putrajaya /ID# 142989
- Hospital Tuanku Ja afar /ID# 142988
- Clinstile, S.A. de C.V. /ID# 144866
- Hosp. Univ. Dr. Jose E. Gonz /ID# 142992
- Invest y Biomed de Chihuahua /ID# 142996
- RM Pharma Specialists, S.A de C.V /ID# 142994
- Hospital de Jesús Nazareno /ID# 142993
- Centro Peninsular de Investiga /ID# 148159
- Waikato Hospital /ID# 143002
- Porter Rheumatology Ltd /ID# 143001
- Timaru Medical Specialists Ltd /ID# 143000
- WroMedica I. Bielicka, A. Strzalkowska s.c. /ID# 145622
- NZOZ Nasz Lekarz /ID# 143004
- REUMED Sp.z o.o. Filia nr 1 /ID# 148189
- Malopolskie Centrum Kliniczne /ID# 152782
- Pratia MCM Krakow /ID# 143005
- McBk Sc /Id# 143003
- Centralny Szpital Kliniczny MSWiA w Warszawie /ID# 151960
- Centrum Medyczne AMED Warszawa Targowek /ID# 157621
- Osteo-Medic spolka cywilna /ID# 143006
- Synexus Polska Sp. z o.o. Oddz. Poznan /ID# 163293
- Synexus Polska Sp. z o.o. Oddz. Poznan /ID# 163294
- Synexus Polska Sp. z o.o. Oddz. Poznan /ID# 163295
- Silmedic Sp z o.o /ID# 152914
- ClinicMed Badurski i wspolnicy SJ /ID# 163300
- Solumed Sp. zoo Cent Medyczne /ID# 152783
- Rheuma Medicus /ID# 143007
- Instituto Portugues De Reumatologia /ID# 148316
- Centro Hospitalar De Vila Nova /ID# 143010
- CCA Braga - Hospital de Braga /ID# 148317
- Hospital CUF Descobertas /ID# 160539
- Centro Hospitalar de Sao Joao, EPE /ID# 152871
- Unidade Local De Saude Do Alto Minho /ID# 143009
- Ponce School of Medicine /ID# 151961
- GCM Medical Group /ID# 143011
- Spitalul Clinic Dr. I. Cantacuzino /ID# 143012
- Spitalul Clinic Dr. I. Cantacuzino /ID# 143017
- Spitalul Clinic Sf. Maria /ID# 144868
- Spitalul Clinic Sf. Maria /ID# 144869
- Spitalul Clinic Sf. Maria /ID# 145966
- Spitalul Clinic de Recuperare /ID# 144867
- Ecomed SRL /ID# 144870
- Family Outpatient clinic#4,LLC /ID# 148319
- Clinical Hospital No.1 n.a. N.I.Pirogov /ID# 143138
- Perm Clinical Center of FMBA /ID# 145627
- LLC Novaya Klinika /ID# 143019
- Kazan State Medical University /ID# 144871
- Tver Regional Clinical Hosp. /ID# 143026
- Сity Clinical Hospital #4 /ID# 143023
- Russian National Research Medi /ID# 143028
- City Clinical Hospital Botkina /ID# 145628
- Moscow State Univ Med and Dent /ID# 145623
- City Clinical Hospital #5 /ID# 148318
- Orenburg State Medical Academy /ID# 143018
- Ryazan State Medical Universit /ID# 143031
- II Dzhan Research Center /ID# 143027
- NW State Med Univ NA Mechnikov /ID# 143022
- Republican clinical hospital n /ID# 145626
- Ulyanovsk Regional Clin Hosp /ID# 143030
- Institute for Rheumatology /ID# 143032
- Institute for Rheumatology /ID# 143035
- Institute for Rheumatology /ID# 143036
- Institute for Rheumatology /ID# 143037
- Special Hospital for Rheuma /ID# 143034
- Clinical Center of Vojvodina /ID# 143033
- MEDMAN s.r.o. /ID# 143045
- Reumatologická ambulancia Reum.hapi s.r.o. /ID# 147169
- REUMACENTRUM s.r.o. /ID# 143041
- Slovak research center Team Member, Thermium s.r.o. /ID# 147614
- Reumex, s.r.o. /ID# 143043
- Reumatologicka ambulancia /ID# 144873
- TIMMED spol. s r.o. /ID# 144872
- Reumatologicka ambulancia, LER /ID# 143044
- ALBAMED s.r.o. /ID# 143042
- Greenacres Hospital /ID# 144710
- Wits Clinical Research Site /ID# 148320
- University of Pretoria /ID# 148353
- Jakaranda Hosp, Emmed Research /ID# 143046
- Jakaranda Hosp, Emmed Research /ID# 145968
- St. Augustine's Hospital /ID# 143047
- Synexus Helderberg Clinical Tr /ID# 148322
- Arthritis Clinical Research Tr /ID# 144874
- Tiervlei Trial Centre /ID# 153085
- Winelands Medical Research Ctr /ID# 143048
- H. Un. Marques de Valdecilla /ID# 143050
- Comple Hosp Univ de A Coruna /ID# 143051
- Hospital Universitario Reina S /ID# 153566
- Clinica Gaias /ID# 143052
- Complejo Hosp Santiago /ID# 153727
- China Medical University Hosp /ID# 143058
- National Taiwan Univ Hosp /ID# 143056
- Kaohsiung Medical University /ID# 143059
- Kaohsiung Chang Gung Memorial Hospital /ID# 143055
- Far Eastern Memorial Hospital /ID# 143061
- Chung Shan Medical University /ID# 143060
- Taipei Veterans General Hosp /ID# 157940
- Linkou Chang Gung Memorial Ho /ID# 143057
- Istanbul Universitesi Cerrahpa /ID# 156088
- Istanbul Fizik Tedavi Rehabilitasyon Egitim ve Arastırma Hastanesi /ID# 143063
- Izmir Katip Celebi Ataturk Training & Research Hospital /ID# 143062
- LLC Revmocentr /ID# 143067
- Lviv Regional Clinical Hospita /ID# 154450
- Vinnytsia Regional Clinical Hospital n.a. M.I.Pyrogov /ID# 143071
- Regional Clinical Hospital /ID# 152025
- NSC-Strazhesko Ist Cardiology /ID# 152030
- Lviv Municipal City Clinical /ID# 143068
- Odessa National Medical Univ /ID# 143072
- Zaporizhzhia Regional Clinical /ID# 143069
- The Royal Free Hospital /ID# 143074
- Queen Alexandra Hospital /ID# 143077
- Warrington + Halton Hosp NHS /ID# 143075
Arms of the Study
Arm 1
Arm 2
Arm 3
Placebo Comparator
Active Comparator
Experimental
Placebo followed by ABT-494
Adalimumab
Upadacitinib
Participants were to receive placebo to upadacitinib orally once daily (QD) and placebo to adalimumab by subcutaneous injection once every two weeks (eow) for up to 26 weeks. Participants who did not achieve a ≥ 20% improvement in tender joint count (TJC) and swollen joint count (SJC) at Weeks 14, 18, or 22 compared to Baseline were to be switched to 15 mg upadacitinib orally QD. At Week 26, all remaining participants were to be switched to 15 mg upadacitinib QD until Week 48 (end of Period 1). Participants who complete Period 1 will continue to receive 15 mg upadacitinib orally QD for up to 5 years in Period 2.
Participants were to receive placebo to upadacitinib orally QD and 40 mg adalimumab by subcutaneous injection eow for up to 48 weeks in Period 1. Participants who did not achieve a ≥ 20% improvement in TJC and SJC at Weeks 14, 18, or 22 compared to Baseline were to be switched to 15 mg upadacitinib orally QD. At Week 26 remaining participants who did not achieve low disease activity (defined as Clinical Disease Activity Index [CDAI] ≤ 10) were to be switched to 15 mg upadacitinib orally QD until Week 48. Participants who complete Period 1 will continue to receive the same treatment assigned at the end of Period 1 (15 mg upadacitinib QD or 40 mg adalimumab eow) for up to 5 years in Period 2.
Participants were to receive 15 mg upadacitinib orally QD and placebo to adalimumab by subcutaneous injection eow for up to 48 weeks in Period 1. Participants who did not achieve a ≥ 20% improvement in TJC and SJC at Weeks 14, 18, or 22 compared to Baseline were to be switched to 40 mg adalimumab eow. At Week 26 remaining participants who did not achieve low disease activity (defined as CDAI ≤ 10) were to be switched to 40 mg adalimumab eow until Week 48. Participants who complete Period 1 will continue to receive the same treatment assigned at the end of Period 1 (15 mg upadacitinib QD or 40 mg adalimumab eow) for up to 5 years in Period 2.