AB1319 EFFICACY AND SAFETY OF THE TREATMENT WITH JAK INHIBITORS IN PATIENTS WITH RA. RESULTS OF A CASE SERIES OF USUAL CLINICAL PRACTICE
Authors: Blanca Hernández-Cruz, Dolores Ruiz-Montesinos, José Javier Pérez Venegas
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> The JAK inhibitors, a new group of targeted synthetic DMARDs were marketed in Spain in 2018. These oral drugs are a good therapeutic alternative for patients with MTX failure. These are not biologic DMARDs and its place in clinical practice is not clear. <h3>Objectives:</h3> To identify the clinical characteristics of the patients treated with JAK inhibitors in a Rheumatology service in the South of Spain. To know the efficacy and safety of these drugs used in usual clinical practice. <h3>Methods:</h3> Setting: Rheumatology department in a 3rd level University Hospital. Design: an observational and analytical case series. From September 2018 to January 15, 2019 clinical data were collected of all patients with RA (ACR/EULAR 2010) treated with JAK inhibitors. The variables collected were demographics, clinical, related to RA, comorbidities, activity (DAS28ESR) and EULAR response. Safety variables included severe adverse events, and adverse events that caused the interruption of the treatment. The protocol was approved and conducted according to the local ethic committee regulations. The statistical analysis was done with descriptive and inferential non parametric tests. Data are shown as median (percentile 25 – percentile 75). <h3>Results:</h3> In the study period, 33 patients were treated with JAK inhibitors. Two patients were excluded of this review due to lack of an evaluation of follow-up. Data of 31 RA patients are presented. They were female (74%) with RF+, ACPA+ and erosive disease en more of 90% of cases; 61% had at least one comorbidity. The Charlson comorbidity index was 3 (2-6). The median age at the time of the start of the JAK inhibitor was 63.3 (56.8 – 70.7) years. The disease duration at the time of the start of the JAK inhibitor was 14.7 (8.6 – 27.5) years. All the patients had received synthetic conventional DMARDs, the number of previous scDMARDs was 2 (2 – 6); 26% had been treated with biologic DMARDs. The number of previous bDMARDS was 2 (1 – 5); 26 (84%) patients were treated with baricitinib and 5 with tofacitinib, oh these 25 (77%) were treated with corticosteroids, the median daily dose of prednisone was 7.5 (5 – 15) mg/day, and 16 (52%) were treated with MTX, the mean weekly dose was 15 (10 – 25) mg/week. The baseline DAS28ESR was 4.9 (4.1 – 5.7) and the end DAS28ESR was of 2.6 (2.07 – 3.5), p&lt;0.0001; the EULAR response was good in 15 (52%), Moderate in 11 (35%) and Poor in 5 (13%). At the last visit 15 (38%) were in remission (DAS28ESR ≤2.6), and the follow-up was of 11.1 (6.8 – 16.7) months. In 8 patients the treatment was stopped, one due to primary inefficacy, three due to secondary inefficacy and in five patients due to adverse events The most relevant adverse events were one case with septic arthritis of the knee after a intra articular injection; one case with a community acquired pneumonia; one case with pyometra, one breast cancer recurrence, one severe neutropenia and one with severe psoriasis flare. There were no thrombotic events. The only variable related with remission was the low baseline DAS. <h3>Conclusion:</h3> The JAK inhibitors are tsDMARD with good profile of efficacy and safety in clinical practice. The patients treated with these drugs had a long and severe disease with failure to several drugs and poor prognostic variables, and a high comorbidity index, however these drugs show good response rates. <h3> Disclosure of Interests:</h3> None declared