Infections in baricitinib clinical trials for patients with active rheumatoid arthritis. Issue 10 (11th August 2020)

• Record Type: Journal Article
• Authors: Winthrop, Kevin L; Harigai, Masayoshi; Genovese, Mark C; Lindsey, Stephen; Takeuchi, Tsutomu; Fleischmann, Roy; Bradley, John D; Byers, Nicole L; Hyslop, David L; Issa, Maher; Nishikawa, Atsushi; Rooney, Terence P; Witt, Sarah; Dickson, Christina L; Smolen, Josef S; Dougados, Maxime
• Is Part Of: Annals of the rheumatic diseases. Volume 79:Issue 10(2020)
• Page Start: 1290
• Page End: 1297
• Publication Date: 2020-08-11
• Subjects: rheumatoid arthritis -- DMARDs (synthetic) -- infections; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2019-216852
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Objectives: To evaluate the incidence of infection in patients with active rheumatoid arthritis (RA) treated with baricitinib, an oral selective Janus kinase (JAK)1 and JAK2 inhibitor. Methods: Infections are summarised from an integrated database (8 phase 3/2/1b clinical trials and 1 long-term extension (LTE)) with data to 1 April 2017. The 'all-bari-RA' analysis set included patients who received any baricitinib dose. Placebo comparison was based on six studies with 4 mg and placebo to week 24, including four trials with 2 mg (placebo-controlled set). Dose–response assessment was based on four studies with 2 mg and 4 mg, including LTE data (2–4 mg extended set). Results: There were 3492 patients who received baricitinib for 7860 patient-years (PY) of exposure (median 2.6 years, maximum 6.1 years). Treatment-emergent infections were higher for baricitinib versus placebo (exposure-adjusted incidence rate (IR)/100 PY: placebo 75.9, 2 mg 84.0 (p not significant), 4 mg 88.4 (p≤0.001)). The IR of serious infection was similar for baricitinib versus placebo and stable over time (all-bari-RA IR 3.0/100 PY). There were 11 cases of tuberculosis (all-bari-RA IR 0.1/100 PY); all occurred with 4 mg in endemic regions. Herpes zoster (HZ) IR/100 PY was higher for baricitinib versus placebo (placebo 1.0, 2 mg 3.1 (p not significant), 4 mg 4.3 (p≤0.01)); rates remained elevated and stable over time (all-bari-RA 3.3). Opportunistic infections, including multidermatomal HZ, were infrequent in the baricitinib programme (all-bari-RA IR 0.5/100 PY). Conclusions: Increased rates of treatment-emergent infections including HZ were observed in patients with RA treated with baricitinib, consistent with baricitinib's immunomodulatory mode of action.