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Master Thesis

Tolérance et efficacité des inhibiteurs de JAK dans la polyarthrite rhumatoïde en comparaison aux DMARDs biologiques : une étude monocentrique

Abstract : Objectives: we aimed to investigate the safety profile of JAK inhibitors (JAKi) in a real-world cohort of rheumatoid arthritis (RA) patients in the university hospital of Bordeaux, in comparison to biologic drug modifying rheumatic diseases (bDMARDs). Secondary objectives were to study the profile of JAKi patients and to assess their efficacy. Methods: we included every RA patients receiving a novel prescription for baricitinib, tofacitinib or a bDMARD between november 1, 2017 and october 10, 2018. We collected clinical and biological data at baseline and during a follow-up of 12 months, with a report of every adverse events (AE) occurrence. Results : 129 patients were included. Patients in the JAKi group had a longer disease duration, a higher history of therapeutics and more structural damages (p <10 –4). We reported 123 AE, with no difference between groups. There was 1 serious AE in JAKi group and 12 in bDMARDs group. Considering all patients, the most preponderant AE was infection with an incidence of 32 %, and a higher number of event per patient in the bDMARDs group (p = 0.05). We recorded only 2 herpes zoster, one in each group, and one tuberculosis in TNFi group. There was more local and systemic allergic reaction in the TNFi group compared to JAKi (p = 0.005). The discontinuation rate because of AE was about 23% in the JAKi group and 24% in the bDMARDs group (p = 0.9). After 6 months of treatments, les JAKi allowed to decrease significantly the DAS 28-CRP from 4.7 (SD ± 1.5) to 3.7 ± 1.6 and the tender joint count from 6 ± 6 to 2 ± 4, whereas TNFi permitted a significant decrease of DAS 28-CRP, DAS 28-ESR, and the tender and swollen joint counts. At 12 months the persistence rate of JAKi was about 51%, 81% for abatacept, 60% for rituximab, 40% for TNFi and 27% for IL-6 inhibitors. Conclusion: safety profile of baricitinib and tofacitinib is acceptable, relatively similar to bDMARDs and concordant with clinical trials results, which is comforting for their larger use.
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Pauline Meunier. Tolérance et efficacité des inhibiteurs de JAK dans la polyarthrite rhumatoïde en comparaison aux DMARDs biologiques : une étude monocentrique. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02493352⟩

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