Tofacitinib May Effectively Alleviate Pain in RA, Psoriatic Arthritis, and Ankylosing Spondylitis

The following article is part of conference coverage from the European League Against Rheumatism (EULAR) Congress 2018 in Amsterdam, The Netherlands. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in rheumatology. Check back for the latest news from EULAR 2018.

Tofacitinib, a Janus kinase inhibitor, may provide a fast and prolonged analgesic effect in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) who are unresponsive to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or to tumor necrosis factor inhibitor (TNFi), as well as in individuals with ankylosing spondylitis, according to a study presented at the Annual European League Against Rheumatism (EULAR) Congress 2018, held June 13 to 16 in Amsterdam, The Netherlands.

For this study, 5 different patient populations from randomized controlled clinical trials were treated twice daily with tofacitinib 5 mg or 10 mg or with placebo: patients with RA resistant to csDMARD treatment (n=2066; pooled from ClinicalTrials.gov identifiers NCT00847613, NCT00856544, and NCT00853385); patients with RA and inadequate response to TNFi (n=399; from ClinicalTrials.gov identifier NCT00960440); individuals with PsA and an inadequate response to csDMARDs (n=316; from ClinicalTrials.gov identifier NCT01877668); individuals with PsA and an inadequate response to TNFi (n=394; from ClinicalTrials.gov identifier NCT01882439); and patients with ankylosing spondylitis (AS) (n=155; from ClinicalTrials.gov identifier NCT01786668).

Pain outcomes were assessed at baseline; 2 weeks; and 1, 3, and 6 months after treatment. Several dimensions of pain were assessed: bodily pain in the past week with the Short-Form Health Survey (SF)-36v2 Q7 and the Bodily Pain Domain (SF-36v2), and pain and discomfort with the EuroQol Five Dimensions Questionnaire Pain/Discomfort Domain (EQ-5D PD). In addition, participants with RA or PsA underwent an Assessment of Arthritis Pain (PAAP); and patients with PsA or AS were evaluated with a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (for neck, hip or back pain in ankylosing spondylitis and other pain). Study participants with PsA had indications of AS at baseline and a BASDAI total score >0.

Tofacitinib treatment led to a reduction in PAAP scores (evaluated with a 0 to 100 mm visual analog scale) from baseline, starting as early as 2 weeks after treatment onset in patients with RA or PsA resistant to csDMARD or TNFi (5 mg tofacitinib: 55.7-65.7 mm at baseline, 45.8-49.8 mm at 2 weeks, and 30.9-34.4 mm at 6 months; 10 mg tofacitinib: 54.4-60.1 mm at baseline, 38.9-44.8 mm at 2 weeks, and 28.2-36.7 mm at 6 months). These changes were greater than those obtained in placebo-treated participants and were comparable in patients with RA and PsA.

Bodily pain and EQ-5D PD scores were improved in all RA and PsA patient groups treated with tofacitinib, and both PsA patient groups had improved BASDAI scores. Tofacitinib treatment resulted in reduced bodily pain, greater EQ-5D PD scores, and improved BASDAI scores for neck, back, and hip pain at 12 weeks vs baseline and compared with placebo in patients with AS.

“Treatment with tofacitinib is associated with a rapid improvement and sustained reduction of pain in patients with RA and [psoriatic arthritis] who are csDMARD-resistant or TNFi-resistant, and in patients with [ankylosing spondylitis],” concluded the study investigators.

Disclosure: The study was sponsored by Pfizer, Inc., which manufactures tofacitinib.

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Reference

Ogdie A, de Vlam K, McInnes IB, et al. Effect of tofacitinib on reducing pain in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Presented at: European League Against Rheumatism (EULAR) Congress 2018; June 13-16, 2018; Amsterdam, The Netherlands. Abstract SAT0221.