Saturday, June 15, 2024

Baricitinib Outperforms TNF-Inhibitors in Treating Rheumatoid Arthritis Post csDMARDs Failure

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In the quest to find the most effective treatment for rheumatoid arthritis (RA) patients who do not respond to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), a recent study provides new insights. The PERFECTRA study, conducted in a real-life treat-to-target (T2T) setting, compared baricitinib, a Janus Kinase inhibitor, with TNF-inhibitors (TNFi). The findings highlight the superior efficacy of baricitinib in achieving significant clinical responses and improving patient-reported outcomes, offering a promising alternative for RA management.

Study Methods and Design

The study included 199 RA patients who were naïve to biological and targeted synthetic DMARDs (b/tsDMARDs) and had a disease duration of five years or less. Participants were randomized to receive either TNFi or baricitinib after failing to achieve disease control with csDMARDs. Clinical and patient-reported outcome measures (PROMs) were evaluated at 12-week intervals for a duration of 48 weeks. The primary endpoint focused on the non-inferiority of the baricitinib strategy in achieving an American College of Rheumatology 50 (ACR50) response at 12 weeks, with additional testing for superiority if non-inferiority was confirmed.

Key Findings

Out of the 199 patients, 102 were assigned to the TNFi group, and 97 to the baricitinib group. Results revealed that baricitinib was not only non-inferior but also superior in achieving the ACR50 response at week 12, with 42% of baricitinib patients reaching this milestone compared to 20% in the TNFi group. Additionally, 75% of baricitinib patients achieved a 28-joint count Disease Activity Score with C-reactive protein (DAS28-CRP) of less than 2.6 at week 12, compared to 46% in the TNFi group.

Throughout the study duration, the baricitinib strategy showed comparable or better outcomes across all clinical measures and PROMs. Importantly, no unexpected safety issues emerged, although the study was not primarily designed to assess safety.

Valuable Insights for Clinical Practice

– Baricitinib demonstrates superior efficacy over TNFi in achieving early clinical responses for RA patients.
– A higher percentage of baricitinib patients reach low disease activity scores (DAS28-CRP

The findings from the PERFECTRA study suggest that baricitinib can be considered a more effective first-line option over TNFi for RA patients who do not respond to csDMARDs. This could potentially lead to a shift in treatment protocols, advocating for the earlier use of baricitinib to achieve better clinical outcomes.

Original Article: RMD Open. 2024 May 30;10(2):e004291. doi: 10.1136/rmdopen-2024-004291.

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