AB0341 SURVIVAL OF REMISSION OR LOW DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH TOFACITINIB. RESULTS OF RUSSIAN NATIONAL REGISTER

Background:

Tofacitinib is an oral Janus Kinase inhibitor for the treatment of rheumatoid arthritis (RA). The survival of remission or low disease activity (LDA) in RA patients, treated with tofacitinib remain unknown.

Objectives:

To evaluate the survival of DAS28 remission or low disease activity in RA patients treated with tofacitinib.

Methods:

Data from 102 patients from Russian national register of patients with RA treated with tofacitinib (OREL), achieved DAS28 remission (DAS28<2.6, n=92) or LDA (DAS28<3.2, n=102) were analyzed. Number of patients with increased disease activity, time of disease activation were registered. Statistical analysis performed with statistical programs SPSS2017 and GraphPadPrizm. p-value < 0.05 considered as significant.

Results:

Baseline characteristics of the patients are presented in table 1.

Table 2.

Treatment results in RA patients, received monotherapy of tofacitinib and tofacitinib with mtx, Mean±SD / n (%).

ParameterLDA (n=102)Remission (n=92)Male, n (%)19 (18.6)15 (16.3)Age, years (mean ±SD)53.55±13.4652.45±12.56Symptoms duration, month (mean±SD)170±111.92169±110.93Positive rheumatoid factor, n (%)41(40.19)36 (39.13)Erosions of hand joints (X-rays), n (%)43(42.15)41 (44.56)BMI, kg/m2(mean ±SD)25.67 ± 2.2226.87 ± 2.19Smokers (current and in the past), n (%)9 (8.82)9 (9.78)

p-value ≥ 0.05 for all the differences.

The remission failed in 45 from 92 patients (48.91%), LDA failed in 65 from 102 of patients (63.72%), table 2.

Table 1.Time, monthMeStandard error95% Confidential IntervalfromToLDA (n=102)12.0002.0218.03915.961Remission (n=92)10.3126.0000.7964.440

Proportions of survival of remission or LDA are presented at figure 1 and figure 2 respectively.

Figure 1.

Survival proportion in RA patients achieved LDA on tofacitinib (n=102).

Figure 2.

Survival proportion in RA patients achieved remission on tofacitinib (n=92).

In 28 from 45 cases of remission failure (62.22%) and in 34 cases from 65 cases of LDA loss (52.3%) the proposal reasons of treatment effect loss were non-medical (absence of reimbursement, changes in patients accommodation, low treatment compliance, etc.). Medical reasons (side effects, inefficacy, etc.) of decrease in remission or LDA survival rate were registered in 17 from 45 cases of remission loss (37.77%) and in 31 from 65 cases of LDA loss (47.69%).

Conclusion:

On-year survival of remission or low disease activity achieved in Rheumatoid arthritis patients treated with tofacitinib is 51.1% and 36.3 % respectively. The main reasons of treatment efficacy loss were associated with non-medical.

Acknowledgments:

Pfizer

Disclosure of Interests:

Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: Pfizer, Novartis, AbbVie, JSC BIOCAD, Сelgene, MSD, Sanofi, V Mazurov: None declared, Alexander Lila: None declared, Andrey Baranov Grant/research support from: Bayer, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Aida Babaeva: None declared, Elena Kalinina: None declared, Tatiana Salnikova: None declared, Valentina Sorotskaya: None declared, Ruzana Samigullina: None declared, Diana Chakieva: None declared, Iuliia Grabovetskaya: None declared, Irina Marusenko: None declared, Ekaterina Gaydukova: None declared, Evgeny Nasonov Speakers bureau: Lilly, AbbVie, Pfizer, Biocad, R-Pharm

THU0206 А VERY EARLY (7-28 DAYS) RESPONSE ON JAK INHIBITOR TOFACITINIB IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS: EFFECT ON PAIN AND CENTRAL SENSITIZATION

Background:

The presence of central sensitization (CS) significantly burdens the course of rheumatoid arthritis (RA). JAK inhibitors block intracellular signal pathways including the ones responsible for synthesis of mediators and cytokines causing pain and CS. The application of JAK inhibitors is supposed to relieve pain and reduce CS severity promptly.

Objectives:

To evaluate JAK inhibitor effect on pain and signs of CS in patients with active RA 7 and 28 days after the start of therapy.

Methods:

Study group included 39 patients with RA, their age was 50.9±11.1, 79.5% of women, 89.7% of RF “+”, DAS28 5.8±0.6, receiving DMARDs (methotrexate 82.0% and leflunomide 18.0%), who were administered with tofacitinib 5 mg 2 times a day due to inefficiency or intolerance of genetically engineered biological drugs. There were assessed the pain severity using Brief pain inventory (BPI) questionnaire, the presence of neuropathic pain component (NPC) using PainDETECT questionnaire and signs of CS using Central Sensitisation Inventory (CSI) questionnaire at early time after tofacitinib administration.

Results:

Patients initially experienced a severe pain – 5.72±2.21 according to the visual analogue scale (VAS), 53.8% had signs of central sensitization (CSI ≥ 40), 17.9% had NPC (PainDETECT ≥18). 7 days after tofacitinib intake there was statistically reliable reduction of pain severity – up to 4.37±2.2 (р=0.01), pain decrease of 29.4±17.9% (BPI), NCP – PainDETECT from 12.9±5.5 to 10.6±5.6 (р=0.047) and CS – CSI from 43.1±12.8 to 35.9±11.2 (р=0.01). The effect had increased after 28 days: pain level (VAS) was 2.84±1.57 (р=0.000), pain decrease of 43.6±29.6% (BPI), PainDETECT 29.8±12.4 (р=0.000), CSI 26.4±13.9 (р=0.000).

During this period there were no serious adverse reactions.

Conclusion:

The application of JAK inhibitor tofacitinib allows to reach a fast analgesic effect, also due to impact on CS and NCP.

Source: National Registry patients with RA

Disclosure of Interests: :

Andrey Karateev: None declared, Ekaterina Filatova: None declared, Elena Pogozheva: None declared, Vera Amirdzhanova: None declared, Evgeny Nasonov: None declared, Alexander Lila: None declared, V Mazurov: None declared, N Lapkina: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Tatiana Salnikova: None declared, Ruzana Samigullina: None declared, Diana Chakieva: None declared, Irina Marusenko: None declared, Olga Semagina: None declared, Marina Semchenkova: None declared

AB0135 A VERY EARLY CLINICAL RESPONSE TO TOFACITINIB IS ASSOCIATED WITH LOW RHEUMATOID ARTHRITIS ACTIVITY AFTER 3 AND 6 MONTHS

Background:

JAK inhibitors block intracellular signaling pathways responsible for the synthesis of cytokines and mediators involved in the development of chronic pain and central sensitization (CS). This determines a very rapid clinical response to JAK inhibitors. However, it is not clear how the significant pain reduction in the first weeks of therapy is associated with the achievement of low rheumatoid arthritis (RA) activity.

Objectives:

to assess the relationship between the early clinical response to tofacitinib and the decrease in RA activity after 3 and 6 months.

Methods:

Study group included 88 patients with RA, their age was 53±11,5, 79.3% of women, 89.8% of RF “+”, DAS28 5.2±1.2, receiving DMARDs (methotrexate 59.5% and leflunomide 19.8%), who were administered with tofacitinib 5 mg 2 times a day due to inefficacy or intolerance of biological DMARDs. There were assessed the pain severity using Brief pain inventory (BPI) questionnaire, the presence of neuropathic pain component (NPC) using PainDETECT questionnaire and signs of CS using Central Sensitisation Inventory (CSI) questionnaire at early time after tofacitinib administration, RA activity using DAS28 after 3 and 6 months.

Results:

The mean pain severity at baseline was 5.3±2.0 according to the visual analogue scale (VAS 0-10), 51.1% of patients had signs of central sensitization (CSI ≥ 40), 15.9% had NPC (PainDETECT ≥18). 7 days after tofacitinib intake there was statistically reliable reduction of pain severity – up to 4.1±1.8 (р<0.05) and CS – CSI from 40.4±13.5 to 36.5±12.5 (р=0.01). After 28 days, the effect was higher: the pain level (VAS) was 2.8±1.6 (p=0.000), PainDETECT decreased from 11.8±5.6 to 6.8±3.1 (p=0.000), CSI – to 31.6±13.9 (p=0.000). DAS28 after 3 and 6 months was 3.7±1.3 and 3.6±1.2. The number of patients with pain decrease of ≥50% after 28 days of therapy was 59.9%. Low RA activity after 3 months. (DAS28 ≤3.2) was achieved in 64.4% of patients. There was a clear correlation between the number of patients with significant pain reduction at 28 days and the number of patients with low RA activity after 3 and 6 months (rS=0.548, p=0.000; rS=0.790, p=0.000). Six patients withdrew from the study due to inefficacy or social reasons. There were no serious adverse reactions.

Conclusion:

The application of JAK inhibitor tofacitinib allows to reach a fast analgesic effect and reduce CS signs. An early clinical response to tofacitinib (pain relief) predicts a decrease in RA activity after 3 and 6 months of the therapy.

Limitation: Open-label observatory study.

Disclosure of Interests:

None declared