Characteristics of clinical manifestations and pharmacotherapy in patients with rheumatoid arthritis requiring switching between biologic disease-modifying antirheumatic drugs and Janus kinase inhibitors

Abstract

Biologic disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKis) do not always allow to achieve remission and low inflammatory activity in rheumatoid arthritis (RA), necessitating switching of therapy. Objective: to evaluate the clinical characteristics and features of pharmacotherapy in patients with RA requiring a switch from bDMARD/JAKi. Material and methods. The study group consisted of 103 patients with RA (85.4% women, mean age 46.9±13.7 years) who had persistent disease activity (DAS28-CRP – 5.42±0.9) despite treatment with bDMARD/JAKi or who experienced adverse events requiring therapy switching. Patients were divided into three groups: Group 1 – patients who underwent one switch (n=50), Group 2 – 2 switches (n=39), Group 3 – ≥3 switches (n=14) of bDMARD/JAKi therapy. Clinical manifestations, disease activity and pharmacotherapy were assessed. Results and discussion. The main reason for switching therapy was ineffectiveness of bDMARD/JAKi (in 81.6% of patients). There was a tendency towards higher DAS28-ESR (p=0.052) and DAS28-CRP values (p=0.057) in groups 2 and 3 compared to group 1, as well as significant differences in CDAI (p1–2=0.015 and p1–3=0.011) and SDAI (p1–2=0.013 and p1–3=0.01). In group 3, there was a tendency towards higher DAS28-CRP, CDAI and SDAI values compared to group 2: 5.82±0.92 and 5.53±0.89; 40.5 [33.0; 45.0] and 35.2 [30.3; 43.9]; 36 [32; 42] and 32.0 [28.5; 38.5], respectively. However, these differences were statistically insignificant. Patients in groups 2 and 3 had a significantly higher number of painful joints compared to patients in group 1 (p1–2=0.048 and p1–3=0.036) and a significantly higher patient global assessment of disease activity (p1–2=0.004 and p1–3=0.013). Patients in group 3 took glucocorticoids significantly longer and at higher doses than patients in group 1. Tumour necrosis factor-α inhibitors were used more frequently in groups 1 and 2 (50.0 and 41.0%, respectively), and interleukin-6 inhibitors in group 3 (50.0%). Conclusion. Patients with RA who required ≥2 switches of bDMARD/JAKi had higher disease activity compared to patients who required only one switch of therapy.

Keywords

• rheumatoid arthritis
• biologic disease-modifying antirheumatic drugs
• janus kinase inhibitors
• switching therapy