الفهرس | Only 14 pages are availabe for public view |
Abstract Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammatory synovitis and progressive joint destruction, which are associated with severe disability and increased mortality. Comorbidities can be seen outside of the musculoskeletal system, and it can lead to many adverse long-term complications. Strict follow up and adequate management is essential to improve the outcome and prevent disease progression and any associated disability. This study was conducted in the Rheumatology and Rehabilitation Department at Sohag University Hospitals, and it included 183 patients with refractory disease to the first-line conventional DMARDs who were followed from the confirmation of the diagnosis of a refractory disease until 24 weeks after the initiation of either TNF Inhibitor or JAK inhibitor. The outcome of patients on these medications was evaluated at enrollment, twelve and twenty-four weeks using Patient Global Assessment scale (PGA), Physical Global Assessment scale (PhGA), Tender Joints Count (TJC), Swollen Joints Count (SJC), Visual Analogue scale (VAS), Disease Activity Score for 28 joints (DAS28), Clinical Disease Activity Index (CDAI), Functional status assessment by Health Assessment Questionnaire Disability Index (HAQ-DI), American College of Rheumatology response criteria ACR 20, ACR50 and ACR70 , as well as Structural joint damage which was measured by the modified Larsen scoring system. In addition, the side effects of these medications were assessed during the study period. Patients were divided into 5 groups, group 1 represented patients who are receiving a JAK inhibitor (Baricitinib), and it included 51 patients; group 2 represented patients who are receiving the TNF inhibitor Golimumab, and it included 38 patients. group 3 represented patients who are receiving the TNF inhibitor Etanercept, and it included 24 patients; group 4 represented patients who are receiving the TNF inhibitor Adalimumab biosimilar, and it included 22 patients, and finally group 5 which was the control group represented patients who are on conventional DMARDs, and it included 48 patients. Results of our study supported the superiority of TNF Inhibitors and JAK Inhibitors over conventional DMARDs in controlling refractory or progressive Rheumatoid arthritis. This was supported by the improvement of all the outcome measures in patients receiving TNF or JAK inhibitor at week12 and 24)123 On comparing Tumor Necrosis Factor (TNF) inhibitors with WJanus Kinase (JAK) inhibitors, results showed significant efficacy of JAK inhibitors over TNF inhibitors as assessed by the American College of Rheumatology Response Criteria for 50% improvement (ACR 50) and 70% improvement (ACR70). These results were observed in week 24, however, in week 12, there was no statistically significant difference between the response of patients in both groups. On the other hand, Modified Larsen Score showed significant superiority of TNF inhibitors over Baricitinib. Side effects were observed in all treatment groups, with cutaneous manifestations being the most observed in TNF inhibitors group. Ranging from simple erythema at the site of injection to multiple subcutaneous abscesses. On the other hand, GI upset was the most common complication in JAK inhibitor group. Infectious complications were the second most observed side effect in both TNF Inhibitors and JAK Inhibitor groups, and they ranged from simple upper respiratory tract and gastrointestinal infections to complex infections that required parenteral antibiotics in less than 2 percent of patients. Conclusions: • TNF Inhibitors and JAK Inhibitors showed superior efficacy in controlling refractory or progressive Rheumatoid Arthritis when compared with conventional DMARDs. • JAK Inhibitors were found to be non-inferior to TNF Inhibitors in the treatment of refractory RA, However, TNF Inhibitors were found to be more effective in the prevention of joint damage and functional disability related to RA. • Given the adverse effects related to both JAK Inhibitors and TNF Inhibitors, suggests that these drugs are reserved as second-line therapy after failure of conventional DMARDs. Study Limitations: Limitations of our study were mainly due to the paucity of studies of the same topic, as well as sample size which was limited by the cost of biological/targeted thera. |