Efficacy and Speed of Pain Relief in Rheumatoid Arthritis When Adding Baricitinib to Methotrexate
The phase III clinical trial RA-BEAM conducted in patients with rheumatoid arthritis (RA) inadequately controlled by methotrexate demonstrated the benefit of adding baricitinib or adalimumab compared to placebo in terms of reducing the number of swollen joints. However, baricitinib showed greater pain relief starting from week 1 compared to placebo and from week 2 compared to adalimumab. Thus, the recently published results of an analysis using the data from this study aimed to compare the proportion of patients who achieved certain pain relief thresholds, the time required for pain relief, and the relationship between the presence of inflammation and pain.
Study Methodology
Baricitinib is an oral selective inhibitor of Janus kinases 1 and 2. The RA-BEAM study was a multicenter, randomized, double-blind study conducted from 2012 to 2015. It enrolled 1305 adult patients with active RA (at least 6 swollen and 6 tender joints and CRP ≥ 6 mg/l) with an inadequate response to methotrexate treatment. Participants were randomized to add baricitinib, adalimumab, or placebo to methotrexate and their pain levels were monitored using a 100mm visual analog scale (VAS) and inflammatory parameters over 24 weeks.
Results
In week 1 of treatment, the proportion of patients achieving ≥ 30%, ≥ 50%, and ≥ 70% pain relief on the VAS was significantly higher in the baricitinib and adalimumab groups compared to the placebo group. By week 4, a significantly higher proportion of patients had achieved at least 30% and 50% pain relief in the baricitinib group compared to the adalimumab group, and by week 8, a greater proportion of patients had achieved at least 70% pain relief with baricitinib compared to adalimumab. Similar results were observed for baricitinib compared to adalimumab at week 24.
Baricitinib was more likely to achieve a pain level on the VAS of ≤ 20 mm and ≤ 40 mm than placebo or adalimumab.
Greater pain relief in the baricitinib group was evident regardless of the levels of inflammatory parameters, such as CRP, erythrocyte sedimentation rate, and the number of swollen joints.
Conclusion
In patients with active RA with an inadequate response to methotrexate treatment, baricitinib led to greater and faster pain relief than adalimumab and placebo. The results of this analysis also suggested that pain relief was not related to inflammation.
(zza)
Source: Taylor P. C., Lee Y. C., Fleischmann R. et al. Achieving pain control in rheumatoid arthritis with baricitinib or adalimumab plus methotrexate: results from the RA-BEAM Trial. J Clin Med 2019; 8 (6): E831, doi: 10.3390/jcm8060831.
Did you like this article? Would you like to comment on it? Write to us. We are interested in your opinion. We will not publish it, but we will gladly answer you.