Evidence map›Paper›PMID 38816210›Full record

Trial reportRMD open2024

PERFECTRA: a pragmatic, multicentre, real-life study comparing treat-to-target strategies with baricitinib versus TNF inhibitors in patients with active rheumatoid arthritis after failure on csDMARDs.

Celine J van de Laar, Martijn A H Oude Voshaar, Peter Ten Klooster, Danyta I Tedjo, Reinhard Bos, Tim Jansen, A Willemze, Grada A Versteeg, Y P M Goekoop-Ruiterman, Eric-Jan Kroot and 1 more

Abstract readMulticenter StudyPragmatic Clinical TrialEquivalence Trial
In one paragraph

Trial report in RMD open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Observational
  4. Review
  5. Review
  6. Observational
  7. Direct Effects of the Janus Kinase Inhibitor Baricitinib on Sensory Neurons.International journal of molecular sciences · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Celine J van de LaarTransparency in Healthcare BV, Hengelo, Netherlands c.vandelaar@tihealthcare.nl.ORCID 0000-0002-9859-1034
Martijn A H Oude VoshaarDepartment of Medical Cell BioPhysics & TechMed Center, University of Twente, Enschede, Overijssel, Netherlands.
Peter Ten KloosterTransparency in Healthcare bv @ University of Twente, Hengelo, Netherlands.
Danyta I TedjoTransparency in Healthcare bv @ University of Twente, Hengelo, Netherlands.
Reinhard BosRheumatology, Medical Centre Leeuwarden, Leeuwarden, Fryslân, Netherlands.
Tim JansenRheumatology, VieCuri Medical Centre, Venlo, Limburg, Netherlands.ORCID 0000-0003-3026-3154
A WillemzeDepartment of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, Netherlands.
Grada A VersteegRheumatology, Deventer Hospital, Deventer, Overijssel, Netherlands.
Y P M Goekoop-RuitermanRheumatology, HagaZiekenhuis, Den Haag, Zuid-Holland, Netherlands.
Eric-Jan KrootRheumatology, Elkerliek Hospital, Helmond, Netherlands.
Mart van de LaarTransparency in Healthcare bv @ University of Twente, Hengelo, Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo compare the effectiveness of a strategy administering baricitinib versus one using TNF-inhibitors (TNFi) in patients with rheumatoid arthritis (RA) after conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) failure in a real-life treat-to-target (T2T) setting.

methodsPatients with biological and targeted synthetic DMARD (b/tsDMARD) naïve RA with disease duration ≤5 years without contraindications to b/tsDMARD were randomised to either TNFi or baricitinib when csDMARD failed to achieve disease control in a T2T setting. Changes in clinical and patient-reported outcome measures (PROMs) were assessed at 12-week intervals for 48 weeks. The primary endpoint was non-inferiority, with testing for superiority if non-inferiority is demonstrated, of baricitinib strategy in the number of patients achieving American College of Rheumatology 50 (ACR50) response at 12 weeks. Secondary endpoints included 28-joint count Disease Activity Score with C reactive protein (DAS28-CRP) <2.6, changes in PROMs and radiographic progression.

resultsA total of 199 patients (TNFi, n=102; baricitinib, n=97) were studied. Both study groups were similar. Baricitinib was both non-inferior and superior in achieving ACR50 response at week 12 (42% vs 20%). Moreover, 75% of baricitinib patients achieved DAS28-CRP <2.6 at week 12 compared with 46% of TNFi patients. On secondary outcomes throughout the duration of the study, the baricitinib strategy demonstrated comparable or better outcomes than TNFi strategy. Although not powered for safety, no unexpected safety signals were seen in this relatively small group of patients.

conclusionUp to present, in a T2T setting, patients with RA failing csDMARDs have two main strategies to consider, Janus Kinases inhibitor versus bDMARDs (in clinical practice, predominantly TNFi). The PERFECTRA study suggested that starting with baricitinib was superior over TNFi in achieving response at 12 weeks and resulted in improved outcomes across all studied clinical measures and PROMs throughout the study duration in these patients.

Indexed as

Antirheumatic AgentsArthritis, RheumatoidAzetidinesPurinesPyrazolesSulfonamidesAdultAgedFemaleHumansMaleMiddle AgedPatient Reported Outcome MeasuresSeverity of Illness IndexTreatment FailureTreatment OutcomeAntirheumatic AgentsAzetidinesbaricitinibPurinesPyrazolesSulfonamidesTumor Necrosis Factor InhibitorsAdalimumabArthritis, RheumatoidBiological TherapyPatient Reported Outcome MeasuresTumor Necrosis Factor Inhibitors

Identifiers

PMID38816210
PMCPMC11328659

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.