AB0422 ACHIEVEMENT OF PATIENT ACCEPTABLE SYMPTOM STATE (PASS) IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH BARICITINIB
Authors: Cristina Garufi, Francesca Spinelli, Fulvia Ceccarelli, Ilaria Duca, Silvia Mancuso, Cristiano Alessandri, Guido Valesini, Fabrizio Conti
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Baricitinib, a newly approved drug for the treatment of patients with moderate to severe rheumatoid arthritis (RA), is a selective inhibitor of Janus kinase 1 and 2. In a patient-centered care, patient-reported outcomes (PROs) are really helpful to better evaluate the disease activity and the response to therapy. Between them, Patient Acceptable Symptom State (PASS) is defined as the highest level of symptoms beyond which patients consider themselves well [1], and consists of a single question with dichotomized answer (yes or no): "Considering all the different ways your disease is affecting you, if you would stay in this state for the next months, do you consider that your current state is satisfactory?". In randomized controlled trials baricitinib showed significant improvement of pain, fatigue, tiredness and assessment of disease [2]. <h3>Objectives:</h3> The aim of the present study was to investigate the effect of baricitinib on PASS one month from the beginning of therapy. Further aim was to quantify the time patients needed to reach an acceptable state of health and determine the clinical variables associated with PASS. <h3>Methods:</h3> Patients affected by RA according to 2010 ACR criteria, starting treatment with baricitinib as clinically indicated, were consecutively enrolled; PASS was determined after 1 month of treatment (T1); days to achieve PASS were estimated at T1; activity indices were calculated after 1 month of therapy and correlated with PASS. <h3>Results:</h3> Thirty-four RA patients were enrolled (age median-IQR 58-16 years; disease duration median-IQR 144-138 months; DAS-28 median-IQR 5.09-1.92). After 1 month of therapy, 30 of 34 patients achieved PASS, of which 73% in the first 2 weeks of treatment (days to achieve PASS median-IQR 12-22) (figure). At T1, patients achieving PASS, compared to those who did not, reported less pain (median VAS 30/100 <i>vs</i> 72/100, p= 0.025), a better global assessment of disease (median 40/100 <i>vs</i> 72/100, p=0.023), lower CDAI (median 12 <i>vs</i> 31, p= 0.048), SDAI (median 12.8 vs 33.95, p=0.011) and DAS-28 (median 3.67 <i>vs</i> 5.54, p= 0.082). 10 out of 30 PASS positive patients (33%) achieved a DAS-28 low-disease activity or remission at T1 <i>vs</i> 0% of the PASS negative cohort (p= 0.169). Age, disease duration and number of previous bDMARDs did not significantly differ between the two subgroups. <h3>Conclusion:</h3> Baricitinib was able to induce an acceptable state of health in about 90% of patients after the first month of therapy. The prompt effect of baricitinib on pain and fatigue could partially explain the rapid achievement of PASS, as shown by the decrease of VAS and improvement of the global assessment of disease. <h3>References</h3> [1] Maksymowych WP, et al. Evaluation and validation of the patient acceptable symptom state (PASS) in patients with ankylosing spondylitis. Arthritis Rheum 2007 [2] Schiff, et al. Patient-reported outcomes of baricitinib in patients with rheumatoid arthritis and no or limited prior disease-modifying antirheumatic drug treatment. Arthritis Res Ther. 2017 <h3>Disclosure of Interests:</h3> None declared