Sholter Dalton, Wu Jianmin, Jia Bochao, Zhang Hong, Griffing Kirstin, Birt Julie, Reis Paulo Jorge Simoes, Liu Huaxiang, Bingham Clifton O
Division of Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, 10839 124 Street NW, Edmonton, AB, T5M 0H4, Canada.
, Edmonton, AB, T6G 2R3, Canada.
Rheumatol Ther. 2022 Apr;9(2):541-553. doi: 10.1007/s40744-021-00415-8. Epub 2022 Jan 6.
Baricitinib has been shown to improve patient-reported outcomes (PROs) in patients with rheumatoid arthritis (RA) who are inadequate responders (IR) to conventional synthetic and biologic disease-modifying antirheumatic drugs (csDMARDs and bDMARDs, respectively). We assessed the ability of baricitinib 2-mg to maintain minimal clinically important differences (MCIDs) in PROs until week 24 among week 4 and 12 responders.
Data were from two phase 3 trials, RA-BUILD (NCT01721057; csDMARD-IR patients) and RA-BEACON (NCT01721044; bDMARD-IR patients). PROs included Pain Visual Analogue Scale, Health Assessment Questionnaire-Disability Index, Functional Assessment of Chronic Illness Therapy-Fatigue, Short-Form 36 Physical Component Score, and Patient's Global Assessment of Disease Activity. Outcomes were evaluated by proportions of patients achieving MCID improvements, number needed to treat (NNT) at weeks 4, 12, and 24, proportions of patients maintaining MCID responses at week 24 among week 4 or 12 responders, and median time to achieve substantial response with baricitinib 2-mg versus placebo.
A higher proportion of baricitinib-treated patients achieved MCID improvements, with NNTs ranging from 5 to 8 for baricitinib 2-mg versus placebo at week 24. Generally, early MCID responses in PROs at weeks 4 or 12 were better maintained through week 24 in RA patients treated with baricitinib 2-mg versus placebo. Patients treated with baricitinib 2-mg also achieved substantial PRO responses or normative values more quickly than placebo.
These results suggest baricitinib-treated patients with RA achieving MCID improvement in PROs at weeks 4 and 12 maintained those improvements over time and that substantial PRO responses were achieved quickly.
对于对传统合成和生物改善病情抗风湿药物(分别为csDMARDs和bDMARDs)反应不足(IR)的类风湿关节炎(RA)患者,巴瑞替尼已显示可改善患者报告结局(PROs)。我们评估了2 mg巴瑞替尼在第4周和第12周有反应者中维持PROs最小临床重要差异(MCIDs)至第24周的能力。
数据来自两项3期试验,RA-BUILD(NCT01721057;csDMARD-IR患者)和RA-BEACON(NCT01721044;bDMARD-IR患者)。PROs包括疼痛视觉模拟量表、健康评估问卷残疾指数、慢性病治疗功能评估-疲劳、简明健康状况调查量表身体成分得分以及患者疾病活动度整体评估。通过达到MCID改善的患者比例、第4周、第12周和第24周的治疗所需人数(NNT)、第4周或第12周有反应者中在第24周维持MCID反应的患者比例以及2 mg巴瑞替尼与安慰剂相比达到显著反应的中位时间来评估结局。
接受巴瑞替尼治疗的患者中达到MCID改善的比例更高,在第24周,2 mg巴瑞替尼与安慰剂相比的NNT范围为5至8。一般而言,与安慰剂相比,接受2 mg巴瑞替尼治疗的RA患者在第4周或第12周PROs中的早期MCID反应在第24周时能更好地维持。接受2 mg巴瑞替尼治疗的患者也比安慰剂更快地达到显著的PRO反应或正常数值。
这些结果表明,在第4周和第12周PROs中达到MCID改善的接受巴瑞替尼治疗的RA患者随时间维持了这些改善,并且迅速实现了显著的PRO反应。