الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 181 |  |  |
| | | from | 181 | | |
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.