Characteristics of clinical manifestations and pharmacotherapy in patients with rheumatoid arthritis requiring switching between biologic disease-modifying antirheumatic drugs and Janus kinase inhibitors
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 ph...
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2024-08-01
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| author | A. O. Bobkova A. M. Lila A. E. Karateev |
| author_facet | A. O. Bobkova A. M. Lila A. E. Karateev |
| author_sort | A. O. Bobkova |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-c4dead8170214e6881b276a6bebefcf5 |
| institution | DOAJ |
| issn | 1996-7012 2310-158X |
| language | Russian |
| publishDate | 2024-08-01 |
| publisher | IMA-PRESS LLC |
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| spelling | doaj-art-c4dead8170214e6881b276a6bebefcf52025-08-20T03:01:21ZrusIMA-PRESS LLCСовременная ревматология1996-70122310-158X2024-08-01184162210.14412/1996-7012-2024-4-16-222698Characteristics of clinical manifestations and pharmacotherapy in patients with rheumatoid arthritis requiring switching between biologic disease-modifying antirheumatic drugs and Janus kinase inhibitorsA. O. Bobkova0A. M. Lila1A. E. Karateev2V.A. Nasonova Research Institute of RheumatologyV.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuing Professional Education, Ministry of Health of RussiaV.A. Nasonova Research Institute of RheumatologyBiologic 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.https://mrj.ima-press.net/mrj/article/view/1616rheumatoid arthritisbiologic disease-modifying antirheumatic drugsjanus kinase inhibitorsswitching therapy |
| spellingShingle | A. O. Bobkova A. M. Lila A. E. Karateev Characteristics of clinical manifestations and pharmacotherapy in patients with rheumatoid arthritis requiring switching between biologic disease-modifying antirheumatic drugs and Janus kinase inhibitors Современная ревматология rheumatoid arthritis biologic disease-modifying antirheumatic drugs janus kinase inhibitors switching therapy |
| title | Characteristics of clinical manifestations and pharmacotherapy in patients with rheumatoid arthritis requiring switching between biologic disease-modifying antirheumatic drugs and Janus kinase inhibitors |
| title_full | Characteristics of clinical manifestations and pharmacotherapy in patients with rheumatoid arthritis requiring switching between biologic disease-modifying antirheumatic drugs and Janus kinase inhibitors |
| title_fullStr | Characteristics of clinical manifestations and pharmacotherapy in patients with rheumatoid arthritis requiring switching between biologic disease-modifying antirheumatic drugs and Janus kinase inhibitors |
| title_full_unstemmed | Characteristics of clinical manifestations and pharmacotherapy in patients with rheumatoid arthritis requiring switching between biologic disease-modifying antirheumatic drugs and Janus kinase inhibitors |
| title_short | Characteristics of clinical manifestations and pharmacotherapy in patients with rheumatoid arthritis requiring switching between biologic disease-modifying antirheumatic drugs and Janus kinase inhibitors |
| title_sort | characteristics of clinical manifestations and pharmacotherapy in patients with rheumatoid arthritis requiring switching between biologic disease modifying antirheumatic drugs and janus kinase inhibitors |
| topic | rheumatoid arthritis biologic disease-modifying antirheumatic drugs janus kinase inhibitors switching therapy |
| url | https://mrj.ima-press.net/mrj/article/view/1616 |
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