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In a phase 2b dose-ranging study of baricitinib in combination with traditional disease-modifying antirheumatic drugs (DMARDs) in RA patients, magnetic resonance imaging showed that baricitinib 2\u2009mg or 4\u2009mg once daily provided dose-dependent suppression of synovitis, osteitis, erosion and cartilage loss at weeks 12 and 24 versus placebo. These findings correlated with clinical outcomes and were confirmed in three phase 3 studies (RA-BEGIN, RA-BEAM and RA-BUILD) using X-rays to assess structural joint damage. In patients na\u00efve to DMARDs (RA-BEGIN study), baricitinib 4\u2009mg once daily as monotherapy or combined with methotrexate produced smaller mean changes in structural joint damage than methotrexate monotherapy at week 24. Differences versus methotrexate were statistically significant for combined therapy. In patients responding inadequately to methotrexate (RA-BEAM study), baricitinib 4\u2009mg plus background methotrexate significantly inhibited structural joint damage at week 24 versus placebo, and the results were comparable to those observed with adalimumab plus background methotrexate. In patients responding inadequately to conventional synthetic DMARDs (csDMARDs; RA-BUILD study), baricitinib 4\u2009mg again significantly inhibited radiographic progression compared with placebo at week 24. Benefits were also observed with baricitinib 2\u2009mg once daily, but the effects of baricitinib 4\u2009mg were more robust. The positive effects of baricitinib 4\u2009mg on radiographic progression continued over 1 and 2\u2009years in the long-term extension study RA-BEYOND, with similar effects to adalimumab and significantly greater effects than placebo. Findings from the phase 3 studies of patients with RA were supported by preclinical studies, which showed that baricitinib has an osteoprotective effect, increasing mineralisation in bone-forming cells. In conclusion, baricitinib 4\u2009mg once daily inhibits radiographic joint damage progression in patients with moderate-to-severe RA who are na\u00efve to DMARDs or respond inadequately to csDMARDs, including methotrexate, and the beneficial effects are similar to those observed with adalimumab.<\/jats:p>","DOI":"10.1186\/s13075-020-02379-6","type":"journal-article","created":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T14:04:16Z","timestamp":1609769056000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Baricitinib inhibits structural joint damage progression in patients with rheumatoid arthritis\u2014a comprehensive review"],"prefix":"10.1186","volume":"23","author":[{"given":"Paul","family":"Emery","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Durez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel J.","family":"Hueber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inmaculada","family":"de la Torre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esbj\u00f6rn","family":"Larsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"Holzk\u00e4mper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiya","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,4]]},"reference":[{"key":"2379_CR1","doi-asserted-by":"publisher","first-page":"624","DOI":"10.3899\/jrheum.121248","volume":"40","author":"M van den Broek","year":"2013","unstructured":"van den Broek M, Dirven L, Kroon HM, Kloppenburg M, Ronday HK, Peeters AJ, et al. 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All patients provided written informed consent.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"PE has received research grants and consulting fees from Abbott, AbbVie, Bristol-Myers Squibb, Pfizer, UCB, Merck Sharp & Dohme, Roche, Novartis, Samsung, Takeda, Eli Lilly, Sanofi and Regeneron Pharmaceuticals, Inc. PD has received speaker fees from BMS, Galapagos and Eli Lilly and Company. AH has received grant\/research support and speaker fees from Eli Lilly and Company. YT reports personal fees from Eli Lilly during the conduct of the study; grant support from Merck Sharp & Dohme and Eisai; grant support and personal fees from Mitsubishi-Tanabe, Takeda, Daiichi-Sankyo, Chugai, Bristol-Myers Squibb, Astellas and AbbVie; and personal fees from Pfizer, Teijin, Asahi-kasei, YL Biologics, Sanofi, Janssen and GlaxoSmithKline outside the submitted work. IdlT, EL and TH are employees and shareholders of Eli Lilly and Company.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"3"}}