Is it possible to maintain low disease activity in rheumatoid arthritis with low dose baricitinib?

This study investigated if reducing the dose of baricitinib (BCB; Olumiant) maintained low disease activity (LDA) in rheumatoid arthritis (RA). They found that a lower dose of BCB maintained LDA in some patients while the others could be rescued by switching to the original dose. 

Rheumatoid arthritis (RA) is a long-term condition caused by inflammation. This causes pain in the joints and over time this also leads to degeneration of joint tissue and disability. To treat RA, patients are prescribed medication to reduce inflammation. The aim of RA treatment is to achieve and maintain low disease activity (LDA) or remission at the lowest drug dose. LDA is a state where RA symptoms are minimal. Remission is a state where there are no significant clinical symptoms.

Baricitinib (BCB) is a medication to treat RA. It works by blocking certain enzymes involved in the production of chemicals that cause inflammation. BCB can effectively manage RA symptoms. It can help patients achieve LDA. It is unclear if a lower dose of BCB can maintain LDA in patients with RA. 

This study included 559 patients with RA. Patients in this study had achieved LDA with 4 mg BCB from a previous trial phase. Patients were randomly assigned to continue taking 4 mg BCB or switch to 2 mg BCB. This lasted 48 weeks. Disease activity was measured at 12, 24 and 48 weeks. If patients did not maintain LDA at 2 mg BCB, they were allowed to switch back to 4 mg BCB. 

LDA was maintained in 80% of 4 mg BCB and 67% of 2 mg BCB patients. Remission was maintained in 40% of 4 mg BCB and 33% of 2 mg BCB patients. Overall, the lower dose of BCB lead to increases in disease activity. Patients in the lower BCB dose were more likely to have a flare of RA symptoms. The rate of non-serious infections was lower in patients taking low dose BCB.

The authors concluded that a lower dose of BCB maintained LDA in some patients and could be rescued by switching to the original dose.

Further investigation is needed to understand why certain patients did not benefit from dose reduction. Low dose BCB may be very useful in clinical practice for some patients. 

If you have any concerns regarding RA treatment, please discuss this with your physician.