Guided therapy selection in rheumatoid arthritis using a molecular signature response classifier: an assessment of budget impact and clinical utility

Jianpi Qingre Tongluo Decoction exerted an anti-inflammatory effect on AS by inhibiting the NONHSAT227927.1/JAK2/STAT3 axis

Purpose

This study aims to determine whether Jianpi Qingre Tongluo Decoction (JQP) alleviates ankylosing spondylitis (AS) inflammation via the NONHSAT227927.1/JAK2/STAT3 axis.

Methods

The effect of JQP on immune-inflammatory indicators in AS patients was explored through a combination of data mining, association rule analysis, and random walk model evaluation. Subsequently, network pharmacology and molecular docking were performed to screen out the potential signaling pathway. ELISA, PCR and wb were used to evaluate the effect of JQP on AS-FLS activity and inflammatory factors. The role of NONHSAT227927.1/JAK2/STAT3 combination in inflammation was studied by editing NONHSAT227927.1 and adding the JAK2/STAT3 inhibitor AG490. Involvement of the JAK2/STAT3 pathway was detected by PCR, WB, or immunofluorescence analysis.

Results

Retrospective data mining results show that JQP can effectively reduce the immune inflammatory response in AS patients. Through network pharmacology and molecular docking, it is speculated that JQP exerts its effect on AS through the JAK2/STAT3 pathway. Overexpression of NONHSAT227927.1 activated the JAK2/STAT3 pathway and promoted the expression of inflammatory factors, while serum containing JQP reversed the effects of NONHSAT227927.1 overexpression. NONHSAT227927.1 silencing inhibits the proliferation of AS-FLSs, inhibits the levels of inflammatory factors, and reduces the expression of JAK2/STAT3 protein. After adding the pathway blocker AG490, it was observed that the cell viability of AS-FLSs was reduced by inflammatory factors and the levels of JAK2/STAT3 were inhibited. , and overexpression of NONHSAT227927.1 can reverse this trend.

Conclusions

JQP exerted an anti-inflammatory effect on AS by inhibiting the NONHSAT227927.1/JAK2/STAT3 axis.

Real-World Treatment and Care Patterns in Patients With Rheumatoid Arthritis Initiating First-Line Tumor Necrosis Factor Inhibitor Therapy in the United States

OBJECTIVE

Treatment guidelines for rheumatoid arthritis (RA) recommend targeting low disease activity or remission and switching therapies for patients not reaching those targets. We evaluated real-world use of disease activity measures, treatment discontinuation, and switching patterns among patients with RA initiating a first-line tumor necrosis factor inhibitor (TNFi).

METHODS

Data from adult patients with RA initiating a first-line TNFi were collected from the American Rheumatology Network (January 2014-August 2021). The proportion of patients with recorded disease activity scores (Clinical Disease Activity Index [CDAI] or Routine Assessment of Patient Index Data 3 [RAPID3]) at TNFi initiation was assessed. Among patients with moderate or severe RA at TNFi initiation, reasons for discontinuation and subsequent advanced therapy were evaluated.

RESULTS

Among TNFi initiators (n = 15,182), 44.8% recorded a CDAI/RAPID3 score at treatment initiation; of those who did not, 47.0% had recorded a tender and/or swollen joint count or pain score. Among patients with moderate or severe RA (n = 1,651), 52% discontinued their initial TNFi during follow-up, of which 15%, 46%, 28%, and 12% initiated the same TNFi, another TNFi, a non-TNFi biologic, or a Janus kinase inhibitor, respectively. The proportion of patients restarting the same TNFi or initiating another TNFi varied according to TNFi discontinuation reason.

CONCLUSION

In clinical practice, over half of patients with RA initiating a first-line TNFi did not have baseline disease activity assessments. Many patients cycled through TNFi despite citing lack of efficacy as the most common reason for discontinuation. Consistent, objective monitoring of treatment response and timely switch to effective therapy is needed in patients with RA.

Real-World Use and Effectiveness Outcomes in Patients with Rheumatoid Arthritis Treated with Upadacitinib: An Analysis from the CorEvitas Registry

INTRODUCTION

Data assessing longer-term real-world effectiveness and treatment patterns with upadacitinib (UPA), a Janus kinase inhibitor, in rheumatoid arthritis (RA) are lacking. We assessed improvement in clinical and patient-reported outcomes and treatment patterns for up to 12 months among adult patients with RA initiating UPA.

METHODS

Data were collected from the CorEvitas® RA Registry (08/2019-04/2022). Eligible patients had moderate to severe RA (Clinical Disease Activity Index [CDAI] > 10) and follow-up visits at 6 or 12 months after UPA initiation. Outcomes were mean change from baseline, percentage achieving minimal clinically important differences (MCID) in clinical and patient-reported outcomes, and disease activity at follow-up. We evaluated clinical outcomes and therapy changes among patients with tumor necrosis factor inhibitor (TNFi) experience and among those receiving UPA as first-line therapy, as well as those receiving UPA as monotherapy versus as part of combination therapy. We further evaluated whether outcomes were similar among those that remained on therapy.

RESULTS

Patients treated with UPA (6-month cohort, N = 469; 12-month cohort, N = 263) had statistically significant improvements (p < 0.001) in mean CDAI, tender/swollen joint counts, pain, and fatigue at follow-up. At 12 months, 46.0% achieved MCID in CDAI and 40.0% achieved low disease activity/remission. Overall, 43.0% discontinued UPA at 12 months; of those receiving combination treatment (N = 90) with conventional therapies and UPA, 42.2% (N = 38) discontinued conventional therapy. Findings were similar in the 6-month cohort and among subgroups. Changes from baseline and proportions of patients achieving MCID or clinical outcomes tended to be numerically lower among patients with TNFi experience and numerically higher among those receiving UPA as first-line therapy.

CONCLUSIONS

UPA initiation was associated with improvements in clinical and patient-reported outcomes, with meaningful clinical improvements regardless of prior TNFi experience, line of therapy, or concomitant use of conventional therapies. Further research is needed to better understand sustained response of UPA over longer treatment periods.