Janus kinase inhibitors in immunoinflammatory diseases: 10 years of clinical practice in rheumatology

Насонов, Е. Л.; Коротаева, Т. В.

doi:10.47360/1995-4484-2022-131-148

Cited by 6 publications

(1 citation statement)

References 181 publications

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“…indicate that the administration of JAK inhibitors sometimes allows the resistance to both TNF-α and IL-6R inhibitors to be overcome. 71,72 This is probably due to the fact that the mechanism of action of JAK inhibitors is not limited to IL-6 signalling but includes other proinflammatory cytokines involved in RA immunopathogenesis.…”

Section: Discussionmentioning

confidence: 99%

Interleukin 6 Inhibition in Rheumatoid Arthritis: Highlight on Olokizumab

Feist¹,

Насонов²

2023

Rheumatology

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Rheumatoid arthritis (RA) is a chronic immunoinflammatory rheumatic disease, which manifests as progressive destruction of joints, systemic inflammation of visceral organs and a wide range of comorbidities associated with chronic inflammation. Among the cytokines involved in the pathogenesis of RA and certain other immunoinflammatory rheumatic diseases, the role of interleukin (IL) 6 is of special interest. The introduction of the monoclonal antibodies tocilizumab and later sarilumab, both of which block the IL-6 receptor, into clinical practice was an important achievement in the treatment of immunoinflammatory rheumatic diseases at the beginning of the 21st century. The humanized monoclonal antibody against IL-6, olokizumab, provides a new mode of action by direct inhibition of IL-6. This article reviews new data on the efficacy and safety of olokizumab in RA and the prospects of its use in rheumatology.

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Section: Discussionmentioning

confidence: 99%

Interleukin 6 Inhibition in Rheumatoid Arthritis: Highlight on Olokizumab

Feist¹,

Насонов²

2023

Rheumatology

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Tofacitinib as a means of optimizing the treatment of rheumatoid arthritis at the outpatient stage (clinical cases)

Bashkova,

Madyanov

2024

Medicinskij sovet

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Two clinical cases of tofacitinib use in the management of rheumatoid arthritis (RA) patients by a rheumatologist at the outpatient stage within the framework of the “Treatment to Target” strategy are presented. The first clinical case describes the case history of a female patient (age 48 years, RA duration 20 years), which demonstrates the difficulties in selecting pathogenetic therapy for late-stage RA. Consecutively prescribed four synthetic baseline anti-inflammatory drugs (methotrexate, sulfasalazine, cyclophosphamide, leflunomide) and two genetically engineered biological drugs (infliximab, rituximab) failed to achieve remission of the disease in the patient. Decrease in disease activity was noted after connection of the third biological drug – etanercept, treatment with which had to be interrupted due to pregnancy planning. The return to the combined treatment after childbirth did not lead to repeated “success”. A positive result was achieved 12 weeks after tofacitinib at a dose of 10 mg/day, which provided a decrease in RA activity to moderate and complete withdrawal of glucocorticoids. Given the incomplete clinical effect, tofacitinib dose was increased to 20 mg/day by the outpatient rheumatologist, which resulted in achieving low RA activity persisting for 5 years. The second case demonstrates the effectiveness of tofacitinib inclusion in the RA treatment regimen as a “second-line” drug. A patient (age 46 years, RA duration 10 years) with long-term drug (methotrexate 25 mg/week) clinical and laboratory remission of RA after an upper respiratory tract infection developed an exacerbation of the disease. Despite three-component therapy with baseline anti-inflammatory drugs, the patient had persistence of high RA activity, which led to the revision of pathogenetic therapy – tofacitinib at a dose of 10 mg/day with clinical effect of the drug after 4 weeks. The achieved clinical and laboratory remission of the disease has been maintained for two years. In outpatient practice tofacitinib can be an effective tool for optimizing RA treatment.

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Impact of tofacitinib on patient-reported outcomes in patients with psoriatic arthritis. Data from the real clinical practice

Vorobyeva¹,

Коротаева²,

Loginova³

et al. 2022

Naučno-praktičeskaâ revmatologiâ

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Objective – to study the effect of tofacitinib (TOFA) on Patient-Reported Outcomes (PROs) in psoriatic arthritis (PsA) patients (pts) activity in real clinical practice.Material and methods. Included 41 patients, predominantly men (58.9%), with a reliable diagnosis of psoriatic arthritis (PsA) according to the CASPAR criteria (2006), and signed informed consent to participate in the study. Mean age – 43.0±10.1 years, PsA duration – 18.6±10.4 years, psoriasis duration – 7.7±7.1 years, disease activity according to DAPSA (Disease Activity in Psoriatic Arthritis) – 44.2±17. At the initial visit, after 3 and 6 months, all patients underwent a standard rheumatological examination. The tender joint number (TJN) out of 68, the swollen joints number (SJN) out of 66 were evaluated, the DAPSA index was calculated, C-reactive protein (CRP, mg/dL), ESR (mm/h), patients with enthesitis and dactylitis in %. The prevalence and severity of psoriasis was determined by BSA (Body Surface Area). Among PROs, the severity of joint pain and disease activity were assessed according to the patient’s opinion of patient global assessment (PtGA) and pain using the visual analogue scale VAS (0–100 mm, respectively), HAQ, RAPID-3, DLQI, PsAID-12. All patients included in the study were prescribed TOFA 5 mg twice a day, followed by a possible increase in the dose to 10 mg twice a day. Also, after 3 and 6 months from the start of therapy, the PASS index (Patient-Acceptable Symptom State) was evaluated, i. e. symptom score below which the patient considers himself healthy, which corresponds to a total PsAID-12 score˂ 4 points and minimal clinically significant improvement (MCID, Minimal Clinical Improvement Disease – change in total PsAID-12 by 3 points).Results. In the whole group, DAPSA was 44.2±17.1, most patients (87.8%) had high PsA activity. By month 3/6 of follow-up, DAPSA significantly decreased to 15.2±12.4/11.8±9.4 (for all p<0.0001). By month 3/6 of TOFA therapy, there was a significant positive trend in all PROs (PtGA Pain, PtGA, BASDAI, HAQ, RAPID-3, FACIT-F, DLQI). Prior to therapy, PsAID-12 was 5.18±2.14. By month 3/6, PsAID-12 significantly decreased to 2.07±1.65/1.68±1.48 (for all p><0.0001). By the 6th month of therapy, MCID was noted in 90.2% of patients. Prior to the start of therapy, PASS was observed in 25.6% of patients. By month 3/6, the number of patients achieving PASS significantly increased to 66.7/71.8%, respectively (for all p><0.0001). By month 3/6 of TOFA therapy, there was a significant positive trend in all PROs (PtGA Pain, PtGA, BASDAI, HAQ, RAPID-3, FACIT-F, DLQI). Prior to therapy, PsAID-12 was 5.18±2.14. By month 3/6, PsAID-12 significantly decreased to 2.07±1.65/1.68±1.48 (for all p<0.0001). By the 6th month of therapy, MCID was noted in 90.2% of patients. Prior to the start of therapy, PASS was observed in 25.6% of patients. By month 3/6, the number of patients achieving PASS significantly increased to 66.7/71.8%, respectively (for all p><0.0001). By the 6th month of therapy, MCID was noted in 90.2% of patients. Prior to the start of therapy, PASS was observed in 25.6% of patients. By month 3/6, the number of patients achieving PASS significantly increased to 66.7/71.8%, respectively (for all p<0.0001).Conclusion. TOFA therapy for 6 months leads not only to a significant decrease in PsA activity, but also to an improvement in overall health according to the patient, assessed by PROs scales and questionnaires (PtGA Pain, PtGA, BASDAI, HAQ, RAPID-3, FACIT-F, DLQI). Dynamics of PsAID-12 shows the achievement of MCID in most patients. Positive dynamics is observed already by the 3rd month of treatment.

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Janus kinase inhibitors in immunoinflammatory diseases: 10 years of clinical practice in rheumatology

Cited by 6 publications

References 181 publications

Interleukin 6 Inhibition in Rheumatoid Arthritis: Highlight on Olokizumab

Interleukin 6 Inhibition in Rheumatoid Arthritis: Highlight on Olokizumab

Tofacitinib as a means of optimizing the treatment of rheumatoid arthritis at the outpatient stage (clinical cases)

Impact of tofacitinib on patient-reported outcomes in patients with psoriatic arthritis. Data from the real clinical practice

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