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Smolen JS, Genovese MC, Takeuchi T, Hyslop DL, Macias WL, Rooney T, Chen L, Dickson CL, Riddle Camp J, Cardillo TE, Ishii T, Winthrop KL. Safety Profile of Baricitinib in Patients with Active Rheumatoid Arthritis with over 2 Years Median Time in Treatment. J Rheumatol 2018; 46:7-18. [PMID: 30219772 DOI: 10.3899/jrheum.171361] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Baricitinib is an oral, once-daily selective Janus kinase (JAK1/JAK2) inhibitor for adults with moderately to severely active rheumatoid arthritis (RA). We evaluated baricitinib's safety profile through 288 weeks (up to September 1, 2016) with an integrated database [8 phase III/II/Ib trials, 1 longterm extension (LTE)]. METHODS The "all-bari-RA" group included patients who received any baricitinib dose. Placebo comparison was based on the 6 studies with 4 mg and placebo up to Week 24 ("placebo-4 mg" dataset). Dose response assessment was based on 4 studies with 2 mg and 4 mg including LTE data ("2 mg-4 mg-extended"). The uncommon events description used the non-controlled all-bari-RA. RESULTS There were 3492 patients who received baricitinib for 6637 total patient-years (PY) of exposure (median 2.1 yrs, maximum 5.5 yrs). No differences in rates of death, adverse events leading to drug discontinuation, malignancies, major adverse cardiovascular event (MACE), or serious infections were seen for 4 mg versus placebo or for 4 mg versus 2 mg. Infections including herpes zoster were significantly more frequent for 4 mg versus placebo. Deep vein thrombosis/pulmonary embolism were reported with 4 mg but not placebo [all-bari-RA incidence rate (IR) 0.5/100 PY]; the IR did not differ between doses (0.5 vs 0.6/100 PY, 2 mg vs 4 mg, respectively) or compared to published RA rates. All-bari-RA had 6 cases of lymphoma (IR 0.09/100 PY), 3 gastrointestinal perforations (0.05/100 PY), 10 cases of tuberculosis (all in endemic areas; 0.15/100 PY), and 22 all-cause deaths (0.33/100 PY). IR for malignancies (0.8/100 PY) and MACE (0.5/100 PY) were low and did not increase with prolonged exposure. CONCLUSION In this integrated analysis of patients with moderate to severe active RA with exposure up to 5.5 years, baricitinib has an acceptable safety profile in the context of demonstrated efficacy. Trial registration numbers: NCT01185353, NCT00902486, NCT01469013, NCT01710358, NCT01721044, NCT01721057, NCT01711359, and NCT01885078 at clinicaltrials.gov.
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Affiliation(s)
- Josef S Smolen
- From the Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria; Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, California, USA; Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan; Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana, USA; Lilly Research Laboratories, Eli Lilly and Co., Kobe, Japan; Oregon Health Sciences University, Portland, Oregon, USA. .,J.S. Smolen, MD, Division of Rheumatology, Department of Medicine, Medical University of Vienna; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University Medical Center; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University; D.L. Hyslop, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; W. Macias, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Rooney, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; L. Chen, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; C.L. Dickson, BS Pharm, Lilly Research Laboratories, Eli Lilly and Co., USA; J. Riddle Camp, BA, Lilly Research Laboratories, Eli Lilly and Co., USA; T.E. Cardillo, MSN, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Ishii, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., Japan; K.L. Winthrop, MD, MPH, Oregon Health Sciences University.
| | - Mark C Genovese
- From the Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria; Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, California, USA; Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan; Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana, USA; Lilly Research Laboratories, Eli Lilly and Co., Kobe, Japan; Oregon Health Sciences University, Portland, Oregon, USA.,J.S. Smolen, MD, Division of Rheumatology, Department of Medicine, Medical University of Vienna; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University Medical Center; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University; D.L. Hyslop, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; W. Macias, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Rooney, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; L. Chen, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; C.L. Dickson, BS Pharm, Lilly Research Laboratories, Eli Lilly and Co., USA; J. Riddle Camp, BA, Lilly Research Laboratories, Eli Lilly and Co., USA; T.E. Cardillo, MSN, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Ishii, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., Japan; K.L. Winthrop, MD, MPH, Oregon Health Sciences University
| | - Tsutomu Takeuchi
- From the Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria; Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, California, USA; Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan; Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana, USA; Lilly Research Laboratories, Eli Lilly and Co., Kobe, Japan; Oregon Health Sciences University, Portland, Oregon, USA.,J.S. Smolen, MD, Division of Rheumatology, Department of Medicine, Medical University of Vienna; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University Medical Center; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University; D.L. Hyslop, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; W. Macias, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Rooney, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; L. Chen, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; C.L. Dickson, BS Pharm, Lilly Research Laboratories, Eli Lilly and Co., USA; J. Riddle Camp, BA, Lilly Research Laboratories, Eli Lilly and Co., USA; T.E. Cardillo, MSN, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Ishii, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., Japan; K.L. Winthrop, MD, MPH, Oregon Health Sciences University
| | - David L Hyslop
- From the Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria; Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, California, USA; Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan; Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana, USA; Lilly Research Laboratories, Eli Lilly and Co., Kobe, Japan; Oregon Health Sciences University, Portland, Oregon, USA.,J.S. Smolen, MD, Division of Rheumatology, Department of Medicine, Medical University of Vienna; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University Medical Center; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University; D.L. Hyslop, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; W. Macias, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Rooney, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; L. Chen, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; C.L. Dickson, BS Pharm, Lilly Research Laboratories, Eli Lilly and Co., USA; J. Riddle Camp, BA, Lilly Research Laboratories, Eli Lilly and Co., USA; T.E. Cardillo, MSN, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Ishii, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., Japan; K.L. Winthrop, MD, MPH, Oregon Health Sciences University
| | - William L Macias
- From the Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria; Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, California, USA; Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan; Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana, USA; Lilly Research Laboratories, Eli Lilly and Co., Kobe, Japan; Oregon Health Sciences University, Portland, Oregon, USA.,J.S. Smolen, MD, Division of Rheumatology, Department of Medicine, Medical University of Vienna; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University Medical Center; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University; D.L. Hyslop, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; W. Macias, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Rooney, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; L. Chen, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; C.L. Dickson, BS Pharm, Lilly Research Laboratories, Eli Lilly and Co., USA; J. Riddle Camp, BA, Lilly Research Laboratories, Eli Lilly and Co., USA; T.E. Cardillo, MSN, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Ishii, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., Japan; K.L. Winthrop, MD, MPH, Oregon Health Sciences University
| | - Terence Rooney
- From the Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria; Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, California, USA; Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan; Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana, USA; Lilly Research Laboratories, Eli Lilly and Co., Kobe, Japan; Oregon Health Sciences University, Portland, Oregon, USA.,J.S. Smolen, MD, Division of Rheumatology, Department of Medicine, Medical University of Vienna; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University Medical Center; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University; D.L. Hyslop, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; W. Macias, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Rooney, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; L. Chen, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; C.L. Dickson, BS Pharm, Lilly Research Laboratories, Eli Lilly and Co., USA; J. Riddle Camp, BA, Lilly Research Laboratories, Eli Lilly and Co., USA; T.E. Cardillo, MSN, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Ishii, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., Japan; K.L. Winthrop, MD, MPH, Oregon Health Sciences University
| | - Lei Chen
- From the Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria; Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, California, USA; Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan; Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana, USA; Lilly Research Laboratories, Eli Lilly and Co., Kobe, Japan; Oregon Health Sciences University, Portland, Oregon, USA.,J.S. Smolen, MD, Division of Rheumatology, Department of Medicine, Medical University of Vienna; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University Medical Center; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University; D.L. Hyslop, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; W. Macias, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Rooney, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; L. Chen, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; C.L. Dickson, BS Pharm, Lilly Research Laboratories, Eli Lilly and Co., USA; J. Riddle Camp, BA, Lilly Research Laboratories, Eli Lilly and Co., USA; T.E. Cardillo, MSN, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Ishii, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., Japan; K.L. Winthrop, MD, MPH, Oregon Health Sciences University
| | - Christina L Dickson
- From the Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria; Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, California, USA; Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan; Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana, USA; Lilly Research Laboratories, Eli Lilly and Co., Kobe, Japan; Oregon Health Sciences University, Portland, Oregon, USA.,J.S. Smolen, MD, Division of Rheumatology, Department of Medicine, Medical University of Vienna; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University Medical Center; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University; D.L. Hyslop, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; W. Macias, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Rooney, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; L. Chen, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; C.L. Dickson, BS Pharm, Lilly Research Laboratories, Eli Lilly and Co., USA; J. Riddle Camp, BA, Lilly Research Laboratories, Eli Lilly and Co., USA; T.E. Cardillo, MSN, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Ishii, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., Japan; K.L. Winthrop, MD, MPH, Oregon Health Sciences University
| | - Jennifer Riddle Camp
- From the Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria; Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, California, USA; Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan; Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana, USA; Lilly Research Laboratories, Eli Lilly and Co., Kobe, Japan; Oregon Health Sciences University, Portland, Oregon, USA.,J.S. Smolen, MD, Division of Rheumatology, Department of Medicine, Medical University of Vienna; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University Medical Center; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University; D.L. Hyslop, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; W. Macias, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Rooney, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; L. Chen, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; C.L. Dickson, BS Pharm, Lilly Research Laboratories, Eli Lilly and Co., USA; J. Riddle Camp, BA, Lilly Research Laboratories, Eli Lilly and Co., USA; T.E. Cardillo, MSN, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Ishii, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., Japan; K.L. Winthrop, MD, MPH, Oregon Health Sciences University
| | - Tracy E Cardillo
- From the Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria; Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, California, USA; Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan; Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana, USA; Lilly Research Laboratories, Eli Lilly and Co., Kobe, Japan; Oregon Health Sciences University, Portland, Oregon, USA.,J.S. Smolen, MD, Division of Rheumatology, Department of Medicine, Medical University of Vienna; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University Medical Center; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University; D.L. Hyslop, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; W. Macias, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Rooney, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; L. Chen, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; C.L. Dickson, BS Pharm, Lilly Research Laboratories, Eli Lilly and Co., USA; J. Riddle Camp, BA, Lilly Research Laboratories, Eli Lilly and Co., USA; T.E. Cardillo, MSN, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Ishii, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., Japan; K.L. Winthrop, MD, MPH, Oregon Health Sciences University
| | - Taeko Ishii
- From the Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria; Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, California, USA; Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan; Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana, USA; Lilly Research Laboratories, Eli Lilly and Co., Kobe, Japan; Oregon Health Sciences University, Portland, Oregon, USA.,J.S. Smolen, MD, Division of Rheumatology, Department of Medicine, Medical University of Vienna; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University Medical Center; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University; D.L. Hyslop, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; W. Macias, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Rooney, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; L. Chen, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; C.L. Dickson, BS Pharm, Lilly Research Laboratories, Eli Lilly and Co., USA; J. Riddle Camp, BA, Lilly Research Laboratories, Eli Lilly and Co., USA; T.E. Cardillo, MSN, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Ishii, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., Japan; K.L. Winthrop, MD, MPH, Oregon Health Sciences University
| | - Kevin L Winthrop
- From the Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria; Division of Immunology and Rheumatology, Stanford University Medical Center, Palo Alto, California, USA; Division of Rheumatology, Department of Internal Medicine, Keio University, Tokyo, Japan; Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana, USA; Lilly Research Laboratories, Eli Lilly and Co., Kobe, Japan; Oregon Health Sciences University, Portland, Oregon, USA.,J.S. Smolen, MD, Division of Rheumatology, Department of Medicine, Medical University of Vienna; M.C. Genovese, MD, Division of Immunology and Rheumatology, Stanford University Medical Center; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University; D.L. Hyslop, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; W. Macias, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Rooney, MD, Lilly Research Laboratories, Eli Lilly and Co., USA; L. Chen, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., USA; C.L. Dickson, BS Pharm, Lilly Research Laboratories, Eli Lilly and Co., USA; J. Riddle Camp, BA, Lilly Research Laboratories, Eli Lilly and Co., USA; T.E. Cardillo, MSN, Lilly Research Laboratories, Eli Lilly and Co., USA; T. Ishii, MD, PhD, Lilly Research Laboratories, Eli Lilly and Co., Japan; K.L. Winthrop, MD, MPH, Oregon Health Sciences University
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