Sarilumab Improves Disproportionate Articular Pain in Rheumatoid Arthritis

Sarilumab improved disproportionate articular pain and clinical outcomes among patients with rheumatoid arthritis.

Compared with placebo, sarilumab improves disproportionate articular pain, which occurs in approximately one-fourths of patients with rheumatoid arthritis (RA). The research findings were published in Rheumatology (Oxford).

Studies have shown that many patients with RA experience pain hypersensitivity to various stimuli, especially after longer disease durations, potentially due to hyperalgesia from both peripheral and central pain mechanisms.

In a post hoc analysis, researchers from the US and UK sought to determine the prevalence of disproportionate articular pain and the related effect of treatment with sarilumab

Researchers collected data from 3 phase 3 randomized controlled trials (MOBILITY, TARGET, and MONARCH) and open-label extension studies on sarilumab. The MOBILITY and TARGET trials compared 200 mg of sarilumab with placebo, while MONARCH compared 200 mg of sarilumab with 40 mg of adalimumab. All open-label studies analyzed the efficacy of 200 mg of sarilumab.

Of 1531 patients with RA included in the analysis, 353 (23%) had disproportionate articular pain at baseline. Patients with vs without disproportionate articular pain scored higher on outcome measures reflecting disease activity, such as the Clinical Disease Activity Index (CDAI), Disease Activity Score using C-reactive protein levels (DAS28-CRP), tender 28-joint count (TJC28), swollen 28-joint count (SJC28), Health Assessment Questionnaire-Disability Index (HAQ-DI), and overall CRP levels.

These data support the concept that other mechanisms (potentially mediated
46 via interleukin 6) in addition to inflammation may contribute to DP in RA.

After treatment with sarilumab for 12 and 24 weeks vs placebo or adalimumab, patients with disproportionate articular pain were more likely to report not having pain. More patients who received sarilumab vs comparator treatments achieved low disease activity levels, regardless of baseline levels of disproportionate articular pain.

In the open-label extension trials, patients with RA who received sarilumab were also less likely to achieve disproportionate articular pain status, and more patients reported decreased use of opioids for pain management.

Study limitations included the use of data from open-label extension studies, such as selection bias, inadequate sample size, unmasking bias, and nonrandomization, and the lack of generalizability of disproportionate articular pain to the entire RA population.

“Our data support the view that disproportionate articular pain is common in patients with RA who have active disease,” the study authors said. “These data support the concept that other mechanisms (potentially mediated via interleukin 6) in addition to inflammation may contribute to disproportionate articular pain in RA,” they added.

Disclosures: This research was supported by Sanofi and Regeneron Pharmaceuticals, Inc. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

References:

Choy E, Bykerk V, Lee YC, et al. Disproportionate articular pain is a frequent phenomenon in rheumatoid arthritis and responds to treatment with sarilumab. Rheumatology (Oxford). Published online November 22, 2022. doi:10.1093/rheumatology/keac659