In a nutshell
This study investigated if switching from adalimumab (Humira) to baricitinib (Olumiant) improves rheumatoid arthritis (RA) symptoms. They found that baricitinib (BAR) improved clinical outcomes in these patients.
Some background
Rheumatoid arthritis (RA) is a chronic condition. It is caused by inflammation that leads to painful swelling in the joints. Reducing inflammation can improve RA symptoms. Disease-modifying anti-rheumatic drugs (DMARDs) are used to treat RA. The aim is to achieve low disease activity (LDA). LDA is a state where RA symptoms are minimal. Over time, some RA drugs become less effective. Switching medication is common in RA.
Adalimumab (ADA) is a biological DMARD (bDMARD). It is an antibody that blocks tumor necrosis factor (TNF). TNF is a chemical messenger that can cause inflammation if there is too much produced. Baricitinib (BAR) blocks enzymes called Janus kinase (JAK) 1 and 2. BAR may be a useful drug in patients that fail to respond to bDMARDs. It is unclear if BAR improves clinical outcomes in patients that no longer respond to ADA.
Methods & findings
This study included 1305 patients with RA. Patients in this trial were initially taking a placebo (488), ADA (330) or BAR (487). At week 16 all patients starting taking BAR. Treatment lasted approximately 52 weeks. The main outcome measured was LDA.
12 weeks after switching, LDA was reduced in ADA patients that switched to BAR. This result was observed in three different RA scales. Pain and physical function scores improved 4 weeks after switching to BAR. This effect was observed for up to 12 weeks. RA activity scores continued to improve over the next 24 weeks in BAR switched patients. Improvement in other clinical outcomes were also maintained.
The bottom line
The authors concluded that switching to baricitinib improved clinical outcomes in patients with RA.
The fine print
This study was an open-label design. Patients were aware that they switched drugs. This could have an effect on the reporting of symptoms including pain.
What’s next?
If you have any concerns regarding RA treatment, please consult with your physician.
Published By :
Annals of the rheumatic diseases
Date :
Apr 30, 2019
