Comparative efficacy of janus kinase therapy and anti-β-cell therapy for patients with rheumatoid arthritis resistant to standard disease modifying anti-rheumatic drugs, based on the results of real clinical practice

Background. In recent years, changes have occurred in the treatment of rheumatoid arthritis (RA): along with genetically engineered biological drugs (GIBD), Janus kinase inhibitors have appeared in real clinical practice. Objective. Comparison of the effectiveness of the two treatment regimens and the rate of stable low disease activity in two groups of patients. Methods. The study included 137 patients with high RA activity who met the ACR (1987) or EULAR/ACR (2010) criteria. The patients had resistance to therapy with disease modifying anti-rheumatic drugs and were GIBP-nai've. 83 patients received tofacitinib (TOFA)+methotrexate (MT), 54 - rituximab (RTM)+MT. The patients were followed up by a rheumatologist for a year. Results. In two groups of patients, there was a significant decrease in disease activity: in the group of patients receiving TOFA+MT, DAS28 decreased from 5.8±1.0 to 3.8±1.2 at the 3rd month of therapy and to 3.1±1.1 after 6 months; at 12 months, DAS28 was 3.1±0.8. The C-reactive protein (CRP) level after a month of therapy decreased from 15.6 (8.0-40.9) to 1.7 (0.5-7.0) mg/L. Low CRP values persisted until the end of follow-up, the median CRP level at the 6th month of therapy was 2.2 (0.7-6.0) mg/L, at the 12th month - 1.7 (0.6-2.5). In the group of patients receiving RTM+MT, DAS28 decreased from 5.9±0.9 to 4.1±1.0 at the 3rd month of therapy and to 3.5±1.2 after 6 months; at the 12th month, DAS28 was 3.3±1.2. The median CRP level decreased from 26(7.7-46.9) to 7(2.9-27.4) mg/L after one month; at the 6th month it was 5.1 (2.2-10.3) mg/L, at the 12th - 3.3 (1.2-12.4). A more rapid decrease in the patient’s pain according to the MS was noted in the RTM+MT group of patients at the 1st month, then the levels of the WAS scores at the 3rd and 12th months became equal. Conclusion. Taking into account the comparable efficacy of the two treatment regimens in real clinical practice, it is advisable to calculate the pharmacoeconomic costs in order to identify more beneficial therapy.

rheumatoid arthritis, JAK inhibitors, tofacitinib, rituximab