AB0271 COMPARISON OF DOSE REDUCTION METHODS BETWEEN RAPIDLY AND GRADUALLY DE-ESCALATION IN RHEUMATOID ARTHRITIS TREATED WITH BARICITINIB OVER 15 MONTHS
Authors: M. Yamasaki
Journal: Annals of the Rheumatic Diseases (2021)

Background: However tsDMARDs and treatment strategies have improved the outcomes of rheumatoid arthritis (RA), it is unknown who can taper or stop tsDMARDs and strategies for de-escalation. Objectives: We analyze predictors of de-escalation in RA patients treated with baricitinib over 15 months in each group who start baricitinib with 4mg/day and 2mg/day. This study will assess and compare (1) characteristic of patients who achieve remission (REM) or low disease activity (LDA) as who can taper baricitinib and (2) two de-escalation methods, rapidly and gradually de-escalation in patients who respond first-line therapy. Methods: Cases were recruited to SHin-yokohama Arthritis REgister (SHARE) between 2015 and 2020 (n=3,961). Patients were diagnosed according to ACR/EULAR 2010 classification criteria and treated with baricitinib started with 4mg/day(n=42) or 2mg/day(n=108) over 15 months. 45 cases fulfilled EULAR definition for difficult-to-treat RA (D2T-RA). In 150 (Male25, Female125 cases, RA duration 12.5+/-5.9years) cases, Clinical Disease Activity Index (CDAI), Health Assessment Questionnaire-Disability Index (HAQ-DI), anti-CCP2 and clinical parameters were analyzed. Two de-escalation methods were compared in this study. In rapidly de-escalation methods, baricitinib were stopped in patients with stable REM/LDA with no swollen joint over 12 weeks. In gradually de-escalation methods, baricitinib were decreased to 50%, 42%, 28%, 14% in order with stable REM/LDA with no swollen joint over 12 weeks. Results: (1)” Detect predictors who can achieve REM/LDA with no swollen joint as starting de-escalation baricitinib” In patients started with baricitinib 4mg/day group, 17 patients achieved REM/LDA with no swollen joint(40.5%), there were no differences in duration of RA, onset age of RA, biologics and/or JAK inhibitors naïve, anti-CCP2 titer and CDAI at the start baricitinib between REM/LDA and non-achieved cases. In patients started with baricitinib 2mg/day group, 59 patients achieved REM/LDA with no swollen joint (54.6%). In 2mg/day group, biologics and/or JAK inhibitors naïve was predictor for achieving REM/LDA with no swollen joint. In 2mg/day group, D2T-RA patients was negative predictor. (2)”Comparison of sustained REM and/or LDA rate between rapidly and gradually de-escalation of baricitinib in rheumatoid arthritis” In whole patients, 15 patients were tapered baricitinib with rapidly de-escalation methods and 61 patients were with gradually de-escalation. Gradually de-escalation methods showed less relapse rate compared with rapidly de-escalation after tapered baricitinib (33.3% vs. 93.8%, p&lt;0.0001). Particularly in 2mg/day group, 12 patients were tapered baricitinib with rapidly de-escalation methods and 47 patients were with gradually de-escalation. Gradually de-escalation methods showed less relapse rate compared with rapidly de-escalation after tapered baricitinib for 32.7 months (33.3% vs. 80.9%, p&lt;0.0001). However 2cases in 4mg/day group and 8cases in 2mg/day showed increase of CDAI, all these cases regain LDA after increasing baricitinib. Conclusion: Tapering baricitinib using gradually de-escalation methods may help to sucseed deduction of baricitinib in RA patients with sustained clinical REM and/or LDA with no swollen joint in each group who start baricitinib with 4mg/day and 2mg/day. References: [1]Ann Rheum Dis 2019;78:171-178 Disclosure of Interests: None declared