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