Effect of Baricitinib and Adalimumab in Reducing Pain and Improving Function in Patients with Rheumatoid Arthritis in Low Disease Activity: Exploratory Analyses from RA-BEAM

J Clin Med. 2019 Sep 5;8(9). pii: E1394

Post hoc analyses from RA-BEAM concluded that BARI 4 mg QD or ADA 40 mg Q2W resulted in improvements in pain, physical function, fatigue and work productivity in patients with RA, independent of the treatment’s impact on inflammation. Among patients achieving remission or LDA, greater improvements in pain and physical function were seen with BARI than with ADA or PBO.Of 1010 patients included in the analysis at Week 24, 168 were in remission, 310 were in remission/LDA and 700 were not in remission/LDA, according to DAS28-ESR criteria. Change from baseline in pain, HAQ-DI, FACIT-F and work-related outcomes were compared between treatment groups according to the remission and LDA status.For patients in remission or LDA, changes from baseline to Week 24 in mean pain VAS and HAQ-DI were significantly greater with BARI than with PBO or ADA. Similar trends were seen for achievements of ‘minimal or no pain’ and normalisation of physical function, although the proportions achieving these endpoints were slightly lower. Work productivity generally improved in all working patients, including those who did not achieve remission or LDA. However, despite meeting DAS28-ESR criteria for remission or LDA, patients continued to experience fatigue across all treatment groups.These results suggest that the assessment of PROs such as pain and function should help clinicians to focus on how RA impacts patient quality of life, rather than considering the inflammatory component in isolation. Patients classed as non-responders using inflammation associated endpoints may still experience benefit and choose to continue with treatment.