Current treatment guidelines for RA hail janus kinase inhibitors (JAKis) alongside biologics as effective therapeutic options for patients refractory to initial conventional synthetic DMARDs. A recent study published in the Oxford Rheumatology has concluded that baricitinib showed a greater treatment retention and equivalent or better treatment response in RA than bDMARDs or tofacitinib.
The cohort data was collected from nationwide Swedish registry for a follow-up period of minimum one year. The corresponding number of subjects administered with baricitinib, tofacitinib, abatacept, IL-6 inhibitors (IL-6is), rituximab, and TNF inhibitors (TNFis) were 1420, 316, 1050, 849, 1101 and 6036. A significantly high drug retention was noted for baricitinib than that of tofacitinib, abatacept, IL-6is and TNFis; whereas drug retention was comparable for tofacitinib, IL-6is and TNFis. In comparison to baricitinib, TNF achieved significant low adjusted 1 year response proportions with a difference of 4.3 percentage points (95% CI 8.7, 0.1) for good EULAR response, 9.9 (14.4 to 5.4) for HAQ-DI improvement and 6.0 (9.8 to 2.2) for CDAI remission. Comparison with non-TNFi bDMARDs also demonstrated favorable results for baricitinib, but not consistently. Although, tofacitinib showed marginally low treatment response than baricitinib, it was similar to that of bDMARDs.
The study by Andrei Barbulescu and co-researchers has provided real-world data suggesting that JAKis has comparable effectiveness as that of bDMARDs, and baricitinib may be superior than TNFis. Moreover, this is the largest population-based study comparing RA patients managed on baricitinib, tofacitinib or bDMARDs.
Reference: Barbulescu A, Askling J, Chatzidionysiou K, Forsblad-d’Elia H, Kastbom A, Lindström U, Turesson C, Frisell T. Effectiveness of baricitinib and tofacitinib compared to bDMARDs in RA: results from a cohort study using nationwide Swedish register data. Rheumatology (Oxford). 2022 Feb 3:keac068.