AB0429 THE EFFICACY OF TOFACITINIB TREATMENT IN RHEUMATOID ARTHRITIS PATIENTSWITH HIGH DISEASE ACTIVITY IN REAL-WORLD PRACTICE
Authors: Irina Menshikova, Yulia Pak, Irina Kolosova
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> JAK-kinase inhibitors are the promising option for patients with severe rheumatoid arthritis (RA). Evaluation of the effectiveness and results of long-term use of tofacitinib (TOFA) seems relevant for clinical practice. <h3>Objectives:</h3> To evaluate the efficacy of TOFA in achievement of remission or low disease activity (LDA) in RA patients after 12 months of treatment and follow-up in real-world practice. <h3>Methods:</h3> In this open study 30 patients (22 women and 8 men) with severe RA (average DAS28&gt;5,8) with inadequate response to methotrexate in effective dose were enrolled and started TOFA 5 mg BID. Average age was 57 (29-71), average disease history – 6,2 (1,5-12,5) years. Patients evaluated at baseline, after3, 6 and 12 months of treatment: number of painful and swollen joints, ESR, CRP, RF, anti-MCV, DAS28, SDAI. The joints ultrasound (US) with Power Doppler (PD) (German US7 score) helped to estimate synovial inflammation. After 12 months of treatment the patients were under follow-up in real-world practice. <h3>Results:</h3> By 3<sup>rd</sup> month of treatment the average mean of ESR and CRP returned to normal range, the number of painful and swollen joints decreased to 2 times, DAS28 - from 5,8 to 3,8, SDAI – from 41,0 to 18,0. 6 patients achieved remission, 3 – LDA, 2 had high activity (DAS28&gt;5,1) and the rest – moderate activity. We achieve the aim of T2T strategy by 12<sup>th</sup> month: average ESR and CRP normalized, DAS28 – 2,92 (1,39; 6,21) and SDAI – 7,0 (1,57; 36,4). 33% of patients achieved remission according to DAS28 and SDAI. RF decreased by 37%, anti-MCV stayed high during the year. There was temporary increase of AST, ALT in 4 patients (13,3%), but did not require TOFA discontinuation. By 12 <sup>th</sup>month of treatment in PDUS mode number of joints with hypervascularized synovium decreased from 3 (2; 7) to 0 (0; 1), number of bone erosions has not changed. 1 patient (3,3%) had severe herpes zoster infection, no other infections occurred. In 1 patient (3,3%) TOFA showed no efficacy (DAS28&gt;6,21). 22 patients have finished 12-months course of TOFA at the moment and moved to follow-up period. 13 of them (59%) continue the same dose of TOFA: 8 have remission and 5 – LDA, 2 patients continued TOFA 5 mg/day for 1 year, then stopped and are in remission for 8 months. 1 patient had temporary withdrawal of treatment due to surgery without exacerbation of RA. 4 patients have stopped TOFA for non-medical reasons: 1 is still in remission and 1 – LDA for 12 months, 2 had worsening of RA and treated by low doses of glucocorticoids. At the moment 3 patients (13,6%) have long-term remission for 18 months after the end of TOFA treatment. <h3>Conclusion:</h3> TOFA is effective and safe treatment option for severe RA in real-world practice. The effect develops by 3 months and continues to grow to 12 months. When remission is achieved, we recommend a reduced dose before withdrawal. Exacerbation of RA is effective solved by retreatment with TOFA. <h3>Disclosure of Interests:</h3> None declared