AB0268 LOW DOSE TACROLIMUS IS AN EFFECTIVE ADD ON THERAPY FOR PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS – A SINGLE CENTRE EXPERIENCE
Authors: N. Prabu, V. Petciappan, G. Anand, T. A, A. Nijish
Journal: Annals of the Rheumatic Diseases (2021)

Background: Rheumatoid arthritis (RA) a chronic inflammatory arthritis requiring tight control of disease activity. While traditional DMARDS have been used effectively, there always remains a need for add on drugs in good number of patients. Tacrolimus since its first approval in 2004 had been used widely as monotherapy and in combination with conventional and biological DMARDS. The primary concern was safety followed by the efficacy for patients with active disease. Objectives: The main objective was to ascertain the safety and tolerability of patients who were treated with tacrolimus as an add on therapy over and above the standard care in RA. Methods: A retrospective analysis of patients who were prescribed Tacrolimus from January 2019 to August 2020 was done. Details of patients along with the change in Blood pressure(BP), Serum creatinine, Blood sugar and Clinical disease activity index(CDAI) before and after tacrolimus were analyzed. Results: A total of 245 patients with active Rheumatoid arthritis received the drug. The mean age was 48.58(1.49) years and the disease duration was 5.9(0.56) years. Of 245 patients, 24 patients were lost to follow up,103 patients stopped the drug for various reasons and 118 patients are still continuing the drug. The mean tacrolimus dose was 1.24 + 0.46 mg in the patients who are continuing. The commonest reason for stopping the drug was adverse events (57%) followed by lack of efficacy(29%), low disease activity (8%)and others(7%). There was no significant change in the mean blood pressure, Blood sugars and Creatinine levels in both the stopped and continuing group. However the CDAI and the steroid dosages reduced significantly in the patients who are still on tacrolimus.The lost to follow up group had high disease activity at baseline and also were on higher doses of steroids. PARAMETERS RA – CONTINUING(118 ) RA STOPPED(103 ) LOST TO FOLLOWUP(24 ) BEFORE TAC AFTER TAC p value BEFORE TAC AFTER TAC P value BEFORE TAC SBP mm of hg 100.44(9.54) 101.06(9.80) 0.67 103(9.77) 104(9.92) 0.44 127.35(10.05) DBP mm of hg 66.30(6.26) 67.22(6.37) 0.30 68.44(6.4) 70.43(6.65) 0.07 82.83(5.05) SUGAR mg 76.43(13.73) 76.67(11.24) 0.95 71.86(10.79) 76.74(14.1) 0.08 89.12(9.7) S.CR mg 0.55(0.06) 0.56(0.09) 0.80 0.66(0.16) 0.57(0.06) 0.21 0.74(0.06) STEROID USE mg 2.82(0.41) 1.65(0.54) &lt;0.001 2.12(0.43) 2.43(0.54) 0.36 2.86(1.42) CDAI 12.28(1.84) 7.42(1.49) &lt;0.001 12.23(2.03) 10.49(2.69) 0.07 16.62(3.88) Conclusion: Low dose Tacrolimus is an effective add on therapy for patients with high disease activity and did not lead to change in serum creatinine, blood pressure or change in blood sugars in the study subjects. References: [1] Yocum D et al. Safety of tacrolimus in patients with rheumatoid arthritis: long-term experience. Rheumatology 2004; 43:992–999. [2] Shouma Dutta,Yasmeen Ahmad. The efficacy and safety of tacrolimus in rheumatoid arthritis.Therapeutic Advances in Musculoskeletal Disease Ther Adv Musculoskel Dis. 2011; 3(6) 283–291. Disclosure of Interests: None declared