Use of tacrolimus for managing csDMARD-failed rheumatoid arthritis: A real- time experience from a single tertiary care centre

Abstract

Aim: To evaluate the efficacy of tacrolimus in achieving disease activity score-28-c-reactive protein 3 [DAS28-CRP (3)] remission in patients managed with tacrolimus at the end of 24 week in a tertiary setting. Methodology: The retrospective study included RA patients who fulfilled American College of Rheumatology (ACR) 2010 criteria and managed by tacrolimus as an add-on to the background DMARD or as a substitute to conventional synthetic DMARD. Apart from demographic data, TJC, SJC, ESR and CRP were recorded at each visit. Subjects were grouped as those who achieved remission (DAS28-CRP (3) <2.6) and not under remission (DAS28-CRP (3)>2.6). Descriptive analysis was carried out for different variables in the classified groups, chi-square test for categorical variables and ANOVA and t-test to compare the continuous variables. Results: The study selected 100 patients who fulfilled the criteria for analysis. The corresponding number of subjects who received 4 mg, 3 mg, 2 mg, 1.5 mg and 1 mg of tacrolimus were 3, 23, 57, 2 and 15 respectively. The corresponding number of patients evaluated at 3, 6, 9 and 12 months were 100, 86, 71 and 56. Around 20% of the patients reached a state of remission by the end of 12 months. The DAS28-CRP (3) remission (<2.6) was achieved in 7 (7%) out of 100 at the end of 3 months, which increased to 17 (20%) out of 86 by 6th month. Around 9 out of 57 maintained the remission till the end of 12 months and 11 (20%) out of 57, who were followed till 12th month, had moderate response. Discriminate function analysis showed that the age and duration of disease were strong predictors of achieving remission. Baseline DAS score and duration of illness at the time of introduction of tacrolimus negatively predicted the patients achieving remission.