Clinical significance of the direct analgesic effect of targeted medications in patients with rheumatoid arthritis
Authors:   AO “EMC”, Moscow, Russian Federation, Zhilyaev E.V. ,   Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation,   Pirogov Russian National Research Medical University, Moscow, Russian Federation, Lukina G.V. ,   Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation,   Research Institute of Rheumatology named after V.A. Nasonova, Moscow, Russian Federation, Koltsova E.N. ,   Research Institute for Healthcare and Medical Management of Moscow Healthcare   Department, Moscow, Russian Federation, Shmidt E.I. ,   City Clinical Hospital No. 1 named after N.I. Pirogov, Moscow, Russian Federation, Lytkina K.A. ,   City Clinical Hospital No. 4, Moscow, Russian Federation
Published: November 2020

Aim: to evaluate the possibility of clinically significant analgesic effect of tofacitinib in patients with rheumatoid arthritis (RA) under the conditions of actual clinical practice. Patients and Methods: data of patients with RA from the Moscow Unified Register of Arthritis (MERA) were analyzed. The subjective indica-tors included tender joint count (TJC), the HAQ (Health Assessment Questionnaire) Functional Capacity Index, the RAPID3 (Routine Assess-ment of Patient Index Data 3) Disease Activity Index. Swollen joint count (SJC) and the level of C-reactive protein (CRP) were analyzed as objective indicators of inflammatory activity. The estimation was conducted of the quotient obtained when subjective indicators were divided by objective indicators in all possible combinations for various targeted medications used in the studied group of patients. Given the observa-tional nature of the study, the search was carried out for confounding factors for all of these quotients. The calculated indices were compared during treatment with various targeted medications, adjusted for detected confounding factors. The process of selecting confounding factors was carried out in 2 stages — preliminary selection of indicators that have a significant one-factor association with the dependent variable, and subsequent reverse stepwise selection of variables within the framework of a generalized linear model.Results: the analysis included 944 episodes of treatment in 832 patients. The duration of episodes was 1312±1006 days. In particular, 93 epi-sodes of tofacitinib treatment were analyzed (average duration — 836±453 days). When the analysis was adjusted for the detected confound-ing factors, it was found that the indicators of TJC/(SJC+1), HAQ/(SJC+1) and RAPID3/(SJC+1) during tofacitinib therapy were significantly lower than the average values obtained with target medications. There were no significant differences between the medications in relation to the studied subjective indicators and the level of CRP.Conclusions: the severity of subjective perceptions and functional disorders in patients treated with tofacitinib may be less with the same severity of arthritis objective indicators compared to genetically engineered anti-inflammatory drugs.KEYWORDS: targeted medication, genetically engineered anti-inflammatory drug, tofacitinib, rheumatoid arthritis, real clinical practice.FOR CITATION: Zhilyaev E.V., Lukina G.V., Koltsova E.N. et al. Clinical significance of the direct analgesic effect of targeted medications in patients with rheumatoid arthritis. Russian Medical Review. 2020;4(8):483–486. DOI: 10.32364/2587-6821-2020-4-8-483-486.