OBJECTIVES: We assessed the relative efficacy and safety of once-daily 
administration of 15 and 30 mg upadacitinib (a JAK1-selective inhibitor) in 
patients with active rheumatoid arthritis (RA).
METHODS: We conducted a Bayesian network meta-analysis to combine the direct and 
indirect evidence from randomized controlled trials (RCTs) that examined the 
efficacy and safety of upadacitinib in patients with active RA.
RESULTS: Five RCTs involving 4381 patients met the inclusion criteria. There 
were 15 pairwise comparisons, including eight direct comparisons and six 
interventions. The ACR20 response rate was significantly higher in the 
upadacitinib 15 and 30 mg + MTX (methotrexate) groups than in the MTX group (OR: 
4.98, 95% CrI: 2.66-10.10; OR: 4.73, 95% CrI: 2.25-10.98). Adalimumab 
40 mg + MTX, upadacitinib 30 mg, and upadacitinib 15 mg groups showed 
a significantly higher ACR20 response rate than did the MTX group. Ranking 
probability based on the surface under the cumulative ranking curve (SUCRA) 
indicated that upadacitinib 15 mg + MTX was likely to achieve the best ACR20 
response rate (SUCRA = 0.838), followed by upadacitinib 30 mg + MTX, adalimumab 
40 mg + MTX, upadacitinib 30 mg, upadacitinib 15 mg, and MTX (SUCRA = 0.784, 
0.495, 0.471, 0.404, and 0.008, respectively). The safety based on the number of 
serious adverse events (SAEs) did not differ significantly among the six 
interventions.
CONCLUSIONS: Upadacitinib 15 and 30 mg administration once daily in combination 
with MTX was the most efficacious intervention for active RA, with no 
significant risk for SAEs.