Clinical Efficacy And Safety Analysis Of Tofacitinib In The Treatment Of EORA

BackgroundRheumatoid arthritis is a autoimmune disease.Elderly onset RA（EORA）is defined as RA with an age of onset≥60 years^[5].Due to the presence of altered pharmacokinetics,immunosenescence and more underlying disease in the elderly,and Patients with EORA differ from other RA in terms of clinical presentation,laboratory tests,and diagnosis and treatment.There are many disease-modifying anti-rheumatic drugs for the treatment of RA that improve the condition,among which tofacitab,an oral targeted synthetic disease-modifying anti-rheumatic drugs,has been shown in many studies to have good efficacy and safety in the treatment of RA.There are few studies on the efficacy and safety of tofacitab in this specific population of EORA.PurposeThree-month follow-up of patients with moderate-to-high disease activity EORA treated with tofacitab in combination with methotrexate（MTX）and Tripterysium Glycosides in combination with MTX.The clinical efficacy and safety of tofacitab in the treatment of EORA patients with moderate to high disease activity was evaluated by observing clinical symptoms and monitoring laboratory test results to provide a reference for the current treatment of EORA patients.MethodsSeventy patients were selected from January 2020 to March 2022 from the Department of Rheumatology and Immunology,Puyang People’s Hospital,Puyang City,who were first diagnosed or treated for at least 3 months and were still at moderate to high disease activity EORA,and were randomly divided into 2 groups。In the observation group of 35,treatment with tofacitab（5mg per dose,2 times daily,orally）in combination with MTX（10 mg per dose,once weekly,orally）.In the control group of 35 cases,treatment with Tripterysium Glycosides（20 mg per dose,3 times daily,orally）combined with MTX（10 mg per dose,once weekly,orally）.The tender joint count,swollen joint count,C-reactive protein（CRP）,erythrocyte sedimentation rate（ESR）,Disease Activity Score-ESR（DAS28-ESR）and Health Assessment Questionnairewere（HAQ）compared between the observation group and control group,1 month and 3 months after treatment to assess the efficacy.The safety of the drugs was evaluated by observing the adverse reactions before and after treatment as well as the changes in blood routine examination,liver function,renal function and blood fat.Finally,SPSS26.0 software was applied for data analysis.Results1.There was no significant difference in age,gender,duration of illness,tender joint count,swollen joint count,C-reactive protein（CRP）,erythrocyte sedimentation rate（ESR）,Disease Activity Score-ESR（DAS28-ESR）and Health Assessment Questionnairewere（HAQ）between the two groups before treatment,p>0.05.2.Efficacy comparison:（1）Comparison of the observation group before and after treatment:The tender joint count（TJC）,swollen joint count（SJC）,ESR,CRP,DAS28-ESR and Health Assessment Questionnairewere（HAQ）were significantly lower at 1 month and 3 months post-treatment compared to pre-treatment,p<0.05.（2）Comparison of the control group before and after treatment:The tender joint count（TJC）,swollen joint count（SJC）did not improve significantly at 1 month and 3 months after treatment compared to before treatment,p>0.05;The CRP and ESR significantly decreased only at 3 months after treatment compared to before treatment,p<0.05;The DAS28-ESR,HAQ scores with a significant decrease at 1 month and 3 months after treatment compared to before treatment,p<0.05.（3）Comparison between the two groups before and after treatment:In the observation group,The tender joint count（TJC）,swollen joint count（SJC）,CRP,ESR,DAS28-ESR and HAQ scores were significantly lower in patients at 1 month and 3 months after treatment compared to the control group,p<0.05.3.Safety comparison:There was no significant difference in the incidence of adverse reactions between the observation group and the control group,P>0.05.ConclusionTofacitab in combination with MTX for moderate to severe EORA reduced the inflammatory response and relieved the clinical symptoms of patients better than Tripterygium Glycosides in combination with MTX,with no increase in adverse effects.