Effects of B/tsDMARDs on Non-inflammatory Pain in Patients with Rheumatoid Arthritis -ANSWER Longitudinal Cohort Study- ACR Meeting Abstracts

Mai Yamashita¹, Takaichi Okano¹, Iku Shirasugi¹, Hirotaka Yamada¹, Keisuke Nishimura¹, Sho Sendo¹, Yo Ueda¹, Toshihisa Maeda², Shinya Hayashi², Wataru Yamamoto³, Akira Onishi⁴, Kosaku Murakami⁵, Hideyuki Shiba⁶, Kenichiro Hata⁶, Kohei Tsujimoto⁷, Kosuke Ebina⁸, Yonsu Son⁹, Naofumi Yoshida⁹, Ryota Hara¹⁰, Ryu Watanabe¹¹, Motomu Hashimoto¹¹, Ryosuke Kuroda² and Jun Saegusa¹, ¹Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan, ²Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan, ³Department of Health Information Management, Kurashiki Sweet Hospital, Kurashiki, Japan, ⁴Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan, ⁵Center for Cancer Immunotherapy and Immunobiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan, ⁶Department of Internal Medicine (Ⅳ), Osaka Medical and Pharmaceutical University, Takatsuki, Japan, ⁷Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Toyonaka, Osaka, Japan, ⁸Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, Toyonaka,Osaka, Japan, ⁹First Department of Internal Medicine, Kansai Medical University, Osaka, Hirakata, Japan, ¹⁰Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan, ¹¹Department of Clinical Immunology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan

Meeting: ACR Convergence 2023

Keywords: Disease-Modifying Antirheumatic Drugs (Dmards), pain, Patient reported outcomes, rheumatoid arthritis

Session Information

Date: Sunday, November 12, 2023

Title: (0423–0459) RA – Treatments Poster I

Session Type: Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Non-inflammatory pain (NIP) is one of the remaining issues in rheumatoid arthritis (RA), and some previous studies suggest that 10-20% of patients with RA remain with NIP even after treatment with biological disease modifying anti rheumatic drugs (bDMARDs). Targeted synthetic DMARDs (tsDMARDs) is reported to improve patient-reported-outcomes including pain, but its effect on NIP is unclear. The aim of this study is to investigate whether tsDMARDs can relieve NIP compared to bDMARDs in RA patients in a longitudinal multicenter cohort study.

Methods: RA patients treated with b/tsDMARDs between 2000 to 2022 and continued the same drug for more than 12 months were included in this study. Unacceptable pain (UP) was defined as patient-visual analog scale (VAS) > 40 mm and was classified to two categories; NIP and inflammatory-pain (IP). NIP was defined as UP with C-reactive protein level < 10 mg/liter. We also assigned a strict definition for NIP (sNIP) as NIP with swollen joint count ≦1. IP was defined as UP without fulfilling the NIP definition. We examined the association between the choice of b/tsDMARDs and the persistence of NIP at month (Mo) 12 using logistic regression model. The frequency of NIP, IP and UP at Mo 0, 3, 6, 9 and 12 were also assessed. Confounding factors (age, sex, disease duration, number of previous b/tsDMARDs, smoking status, stage, class, titer of rheumatoid factor and anti-citrullinated protein/peptide antibodies, dose of methotrexate and prednisolone, the use of painkillers and disease activity at baseline) were adjusted with inverse probability of treatment weighting estimated by generalized propensity score. Missing data were dealt with multiple imputation to calculate generalized propensity score.

Results: Of 1880 treatment courses (TCs), 1704 TCs were treated with bDMARDs and 176 TCs were treated with tsDMARDs. The rate of UP at baseline was 61.8% in bDMARDs and 63.8% in tsDMARDs. These rates decreased significantly to 32.2% in bDMARDs (p < 0.001) and 34.2% in tsDMARDs (p < 0.001) at Mo 3, respectively, which remained stable at Mo 12. The rates of IP in both bDMARDs and tsDMARDs also significantly declined at Mo 3, and then remained stable at Mo 12. On the other hand, NIP was present in 28.8% of TCs in bDMARDs and 36.2% of TCs in tsDMARDs at baseline, which remained in 25.6% and 26.1% at Mo 12, respectively (figure). Analysis with sNIP did not change the trend. The proportion of NIP in UP was 46.6% in bDMARDs and 56.8% in tsDMARDs at baseline, which increased to 87.5% and 80.7% at Mo 12. There was no statistically significant difference in frequency of NIP at Mo 12 among b/tsDMARDs in both definitions [NIP: adjusted odds ratio (OR) = 0.79 (95% confidence interval (CI) : 0.53-1.18, p = 0.25), sNIP: adjusted OR = 0.73 (95%CI : 0.46-1.14, p = 0.16)].

Conclusion: In RA patients who were able to continue b/tsDMARDs for 12 months, the effects of tsDMARDs against NIP was comparable to that of bDMARDs. The frequency of RA patients with NIP treated with b/tsDMARDs for 12 months remained 25%, while that of IP were decreased.

Time-dependent changes in pain of patients treated with b/tsDMARDs

Disclosures: M. Yamashita: None; T. Okano: None; I. Shirasugi: None; H. Yamada: None; K. Nishimura: None; S. Sendo: Eli Lilly, 5; Y. Ueda: None; T. Maeda: None; S. Hayashi: None; W. Yamamoto: None; A. Onishi: None; K. Murakami: None; H. Shiba: None; K. Hata: None; K. Tsujimoto: None; K. Ebina: Abbvie, 5, 6, Amgen, 6, Asahi-Kasei, 5, 6, Astellas, 6, Ayumi, 6, Bristol-Myers Squibb(BMS), 6, Chugai, 6, Daiichi-Sankyo, 6, Eisai, 5, 6, Eli Lilly, 6, Janssen, 6, Mitsubishi-Tanabe, 5, 6, Ono Pharmaceutical, 6, Pfizer, 6, Sanofi, 6, Taisho, 6, Teijin Pharma, 5, UCB Japan, 6; Y. Son: Abbvie G.K., 6, Bristol-Myers Squibb(BMS), 6, Chugai Pharmaceutical CO., Ltd., 6, Eisai CO., Ltd., 6, Jansen Pharmaceutical K.K., 6; N. Yoshida: None; R. Hara: AbbVie, 6, Asahi-Kasei, 6, Eisai, 6, Eli Lilly, 6; R. Watanabe: AbbVie, 5, Asahi Kasei, 6, Chugai, 6, Eli Lilly, 6, GlaxoSmithKlein(GSK), 6, Sanofi, 6; M. Hashimoto: Abbvie, 5, 6, Asahi Kasei, 5, 6, Astellas, 5, 6, Ayumi, 5, 6, Brystol Meyers, 5, 6, Chugai, 5, 6, Daiichi Sankyo, 5, 6, EA Pharma, 5, 6, Eisai, 5, 6, Eli Lilly, 5, 6, Novartis Pharma, 5, 6, Taisho Toyama, 5, 6, Tanabe Mitsubishi, 5, 6; R. Kuroda: None; J. Saegusa: None.

To cite this abstract in AMA style:

Yamashita M, Okano T, Shirasugi I, Yamada H, Nishimura K, Sendo S, Ueda Y, Maeda T, Hayashi S, Yamamoto W, Onishi A, Murakami K, Shiba H, Hata K, Tsujimoto K, Ebina K, Son Y, Yoshida N, Hara R, Watanabe R, Hashimoto M, Kuroda R, Saegusa J. Effects of B/tsDMARDs on Non-inflammatory Pain in Patients with Rheumatoid Arthritis -ANSWER Longitudinal Cohort Study- [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/effects-of-b-tsdmards-on-non-inflammatory-pain-in-patients-with-rheumatoid-arthritis-answer-longitudinal-cohort-study/. Accessed .

« Back to ACR Convergence 2023

ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-b-tsdmards-on-non-inflammatory-pain-in-patients-with-rheumatoid-arthritis-answer-longitudinal-cohort-study/