Baricitinib in the treatment of rheumatoid arthritis in routine clinical practice – results from the Czech National ATTRA Registry

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Authors: K. Pavelka ¹; Z. Křístková ²; L. Nekvindová ^2,3
Authors‘ workplace: Revmatologický ústav, Praha ¹; Institut biostatistiky a analýz, s. r. o. ²; 1. lékařská fakulta Univerzity Karlovy, Praha ³
Published in: Čes. Revmatol., 29, 2021, No. 3, p. 133-143.
Category: Original article

Overview

Baricitinib is a new immunosuppressive drug for the treatment of rheumatoid arthritis (RA). It is a small molecule, specifically a JAK inhibitor, which intracellularly inhibits signal transduction and activation of proinflammatory cytokines. The authors conducted an open, retrospective study in the national ATTRA registry to obtain data from routine clinical practice with this drug in the Czech Republic. The study included 243 patients with a mean age of 44 years and a disease duration of 13 years. The initial activity was high with the mean CRP of 19.1 mg/L, the number of swollen joints of 8, and the DAS 28 of 5.6. After one year of treatment, there was a significant decrease in all indicators of activity. Remission was achieved in about 39.3% of patients and low activity (assessed by DAS 28) in about 68.8% of patients. Retention on treatment was 71.8% after 12 months. All components of quality of life have improved significantly. Furthermore, some predictive factors of achieving a state of low activity or remission were evaluated. Patients receiving baricitinib as the third biological or targeted synthetic DMARD have been shown to have a worse response than patients with earlier use of baricitinib. Specifically, a statistically significant difference was found compared to the first line. There was also worse retention on the drug. Another predictive factor for remission evaluated at the start of treatment was concomitant MTX treatment, which was not predictive of remission or persistence in remission. Another predictive factor for remission and low activity at the beginning of treatment was the initial level of disease activity. Patients with moderate activity had a significantly lower DAS 28 after three months of treatment than patients with high activity at baseline, but after 12 months, this difference was no longer significant. In conclusion, baricitinib is an effective tsDMARD in the treatment of RA in monotherapy and in combination with MTX. There is a better chance of achieving remission after the failure of MTX and two bDMARDs; after the failure of the third and other bDMARDs the chance of achieving remission is lower.

Keywords:

rheumatoid arthritis – biological treatment – baricitinib

Sources

Smolen J, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet 2016; 388/100055/2023_2038 http.doi.org/10.1016/ S0140_6736/16/301173-8
Smolen JS, Aletaha D, Bijlsma JW, et al. Treating rheumatoid arthritis to target: Recommendation of an international task force. Ann Rheum Dis 2010; 69(4): 631–637.
Yamaoka K. Janus kinase inhibitors for rheumatoid arthritis. Curr Opin Chem Biol 2016; 32: 29–33.
Angelini J, Tallota R, Roncato R, et al. JAK – Inhibitors for the treatment of rheumatoid arthritis: A focus on the present and an outlook on the future Biomolecules 2020; 10: 1002. doi:10.3390/biom10071002
Fleischmann R, Mysler E, Hall S, et al. Efficacy and safe[1]ty of tofacitinib monotherapy, tofacitinib with methotrexate and adalimumab with methotrexate in patients with rheuma[1]toid arthritis (ORAL STRATEGY): a phase 3b/4 double blind, head to head, randomised, controlled trial. Lancet 2017; 390: 457–468.
Taylor PC, Keystone EC, van der Heijde D, et al. Baricitinib versus placebo or adalimumab in rheumatoid arthritis. N Engl J Med 2017; 376: 652–662.
Fleischmann R, Pangan AL, Song IH, et al. Upadacitinib Versus Placebo or Adalimumab in Patients With Rheumatoid Arthritis and an Inadequate Response to Methotrexate: Results of a Phase III, Double-Blind, Randomized Controlled Trial. Arthritis Rheumatol 2019; 71(11): 1788–1800. doi:10.1002/art.41032 [Epub 2019 Aug 28].
Taylor P. Clinical efficacy of a lunched JAK inhibitors in rheu[1]matoid arthritis. Rheumatology 2019; 58: i17–i26.
Smolen J, Landewe RBM, Bijlsma JWK, et al. EULAR recommen[1]dations for the management of rheumatoid arthritis with synthetic and biological disease – modifying antirheumatic drugs, 2019 update. Ann Rheum Dis 2015. doi:10.1136/an[1]nrheumdis. 2019-216655
Jamilloux Y, Jammal T, Vuiton L, et al. JAK inhibitors for the treatment of autoimmune and inflammatory diseases. Autoimmunity Reviews 2019; 18: 102390. https://doi.or[1]g/10.1016/j.autrev.2019-102390
Fleischmann R, Schiff M, van der Heijde D, et al. Baricitinib, methotrexate, or combination in patients with rheumatoid arthritis and no or limited prior disease-modifying antirheuma[1]tic drug treatment. Arthritis Rheum 2017; 69: 506–517.
Genovese MC, Kremer J, Zamani O, et al. Baricitinib in pa[1]tients with refractory rheumatoid arthritis. N Engl J Med 2016; 374: 1243–1252.
Dougados M, van der Heijde D, Chen YC, et al. Baricitinib in patients with inadequate response or intolerance to conventional synthetic DMARDs: results from the RA-BUILD study. Ann Rheum Dis 2017; 76: 88–95.
Smolen JS, Kremer JM, Gaich CL, et al. Patient-reported out[1]comes from a randomised phase III study of baricitinib in pa[1]tients with rheumatoid arthritis and an inadequate response to biological agents (RA-BEACON). Ann Rheum Dis 2017; 76: 694–700.
Šenolt L, Mann H, Závada J, Pavelka K, Vencovský J. Doporučení České revmatologické společnosti pro farmakote[1]rapii revmatoidní artritidy 2017. Čes. Revmatol. 2017; 1: 8–24.
Takahashi N, Asai S, Kobayakawa T, et al. Predictors for clinical effectiveness of baricitinib in rheumatoid arthritis pa[1]tients in routine clinical practice: data from a Japanese mul[1]ticenter registry. 2020. https://doi.org/10.1038/s41598-020- 78925-8
Nagy G, Rodenwijs MT, Welsing PM, et al. EULAR definition of difficult to treat rheumatoid arthritis. Ann Rheum Dis 2021; 80: 31–35

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Article was published in

Czech Rheumatology

2021 Issue 3