SAT0230 Comparison of efficacy of tofacitinib vs. etanercept treatment in rheumatoid arthtritis patients with high activity disease by ultrasound evaluation with power doppler (1 YEAR TREATMENT PERIOD).
Authors: I. Menshikova, N. Dzhenzhera, Y. Pak, I. Kolosova
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> Modern clinical recomendations rule us to timely and rational treatmrnt of rheumatoid arthritis (RA) patients with biologics or tofacitinib when traditional DMARDs failed in achievement of remissin or low disease activity (LDA). Ultrasound power Doppler (PD) was recently recommended by some investigators for accuracy of evaluation of local inflammation in small joints to predict the possible flares of RA. <h3>Objectives:</h3> To compare the efficacy of tofacitinib vs. etanercept in real clinical practice by complex evaluation including PD during 1-year treatment of RA patients with high disease activity. <h3>Methods:</h3> In this randomized open study, we assign 30 patients to receive either etanercept 50 mg subcutaneous weekly (10 pts) or tofacitinib 5 mg BID orally (20 pts). There are 21 females and 9 males with severe RA (average DAS 28 &gt;5,8) with inadequate response to methotrexate in effective dose enrolled into the study. Average age was 48.2±5.6 (42,1 for etanercept group and 51,9 for tofacitinib group), average disease history was 5,3 (1,5–25) years. Patients evaluated at baseline, after 3, 6 and 12 months of treatment: number of painful and swollen joints, ESR, C-protein, RF, anti-MCV, DAS 28, SDAI, ultrasound examination of hands and feet (German US7 score) by grey scale (GS) and power Doppler (PD). <h3>Results:</h3> Patients in both groups had statistically significant decrease of disease activity. In etanercept group median DAS 28 decreased from 6.05 to 2.5 (p&lt;0.001), 5 pts achieved remission, 3 –LDA. In tofacitinib group median DAS 28 decreased from 5.86 to 3.23 (p&lt;0.001), 5 pts achieved remission, 3 – LDA. Number of painful and swollen joints decreased to 3–8 times, ESR and C-protein normalized in 8 patients in etanercept group and 12 pts in tofacitinib group. SDAI evaluation showed lowing down the score of activity from range 37,10 to range 6,50 in etanercept group and from 40,78 to 14,25 in tofacitinib group. US dynamics: median GS score decreased from 6.5 to 2,5 (p&lt;0.01) in etanercept group and from 8 to 3 (p&lt;0.01) in tofacitinib group. Number of bone erosions still unchanged. In PD mode number of joints with hypervascularized synovium decreased from 3 to 0 (p&lt;0.001) in both groups. Also it was noticed that by 3rd month of the treatment LDA was achieved for 2 patients (out of 10) in etanercept group and 5 (out of 15) in tofacitinib one, and relatively by 12 month – 8 in etanercept group and 8 in tofacitinib. The most significant decrease of SDAI (more than 2 times) was achieved by 3rd month and go further with the same dynamics in etanercept group and slightly less in tofacitinib group. <h3>Conclusions:</h3> Integrated evaluation of efficacy of treatment of patients with severe RA showed that both etanercept and tofacitinib have good effect in achieving of remission or LDA (DAS28 and SDAI). Tofacitinib acts similar to etanercept in 3 months of therapy, but then its effect progressed more slowly. PD is additional method of monitoring of sinovial inflammation and shows us the significant regression of tissue hypervascularisation (activity of inflammation) by 6 months of treatment both etanercept and tofacitinib. Follow up of patients within the year and later on helps to adjust therapy. <h3>Disclosure of Interest:</h3> None declared