Baricitinib may effectively slow down progression of joint damage in patients with RA

This study reviewed the effectiveness of baricitinib (Olumiant) on the progression of structural joint damage (SJD) in patients with rheumatoid arthritis (RA).

The data showed that baricitinib may significantly help slow down SJD signs found in digital imaging in patients with non-existent or insufficient response to standard treatment drugs.

RA is a chronic inflammatory disease. The inflammation leads to severe symptoms and consequences. Symptoms can be swelling, pain, fatigue, and physical limitations that, on their part, can lead to decreased productivity in different areas of life. Ultimately, the patients’ quality of life may reduce drastically. Inside of the body, the process of inflammation can cause SJD. This can show as inflammation of the joint capsule (synovitis) or bone itself (osteitis). It may also lead to cartilage loss or loss of bone material (bone erosion).

The state of SJD (radiographic progression) can be determined by the examination of images like MRI and x-rays. It might be visible, for example, if the space between joint partners has reduced (joint space narrowing). This is most likely related to the patients’ symptoms. 

Several drug options aim to slow down SJD as much as possible. Biologic drugs like adalimumab (Humira) aim to slow down inflammation. Disease-modifying drugs (DMARDs) like methotrexate (Trexall) influence the immune system to decrease inflammation. If these do not work well or at all, Janus-kinase-inhibitors (JAK-inhibitors) like baricitinib can be prescribed. They block signals of immune cells to ease symptoms.

Baricitinib is an emerging drug that has been shown to reduce symptoms of RA. Its effectiveness in slowing down SJD remains under investigation.

This review study gathered, examined, and compared the data of several other studies. The studies included patients with early or moderate to severe RA. The patients previously did not respond well or at all to DMARDs. The applied dosage of baricitinib was 1 mg to 8mg daily. The effectiveness of baricitinib on SJD was determined by the evaluation of digital images as well as results of patient-questionnaires. 

In comparison to the placebo, patients treated with 4mg baricitinib daily showed significantly reduced synovitis and osteitis after 12 weeks. They also showed significantly fewer signs of joint destruction. In the same study, patients receiving 2mg baricitinib daily showed similar but less strong and stable results. 

Another study compared baricitinib and methotrexate as combination therapy to either drug alone in 588 patients. The combination therapy and baricitinib alone were more successful. 77% of patients in the baricitinib-group and 78% in the combination therapy group showed good responses to the treatment after 24 weeks. This was compared to 62% in the methotrexate alone group.

A comparison between placebo, baricitinib, and adalimumab in 1307 patients showed that significantly more baricitinib-treated patients (70%) showed no SJD progression than adalimumab-treated patients (61%) after 12 weeks. A dose of 4mg baricitinib showed to have continuous positive effects over one and two years.

The authors concluded that 2mg or 4mg baricitinib daily may significantly slow down SJD in patients with RA and insufficient response to DMARDs. They noted that results were similar to adalimumab.

This data review was funded by Eli Lilly and Company, the manufacturer of baricitinib. Definitions of terms across studies might have varied. This might limit their comparability.