Switching between JAK inhibitors could be beneficial in certain subset of RA patients

The findings of a Swiss-based study published in Rheumatology journal reported that switching to another JAK inhibitors contributed to a higher drug retention in RA patients who discontinued JAK inhibitor therapy, as opposed to switching to TNF inhibitors.

The prospective observational study carried out by Amstad et al. considered the data for 400 JAK inhibitor treatment courses. This date was collected from 364 patients enrolled in Swiss RA registry SCQM, who switched the treatment to either another JAK inhibitor, a TNF inhibitor, or a biologic DMARD.

Tofacitinib was the most commonly used initial JAK inhibitor (83.2%) followed by baricitinib (16.5%) and upadacitinib (0.2%). The median days of initial treatment discontinuation noted was 232. The corresponding percentages of subjects switched to another JAK inhibitor, a TNF inhibitor and biologic DMARD were 20.2%, 31.3% and 48.5%. The median drug retention times noted for the respective treatments were 918 days, 335 days, and 508 days. The reasons noted by the consulting rheumatologist for treatment discontinuation were lack of effectiveness (57.2%) and adverse events (27.8%).

The researchers found that the risk for drug discontinuation was significantly lower among subjects who switched to another JAK inhibitor (52%) when compared to those who switched to a TNF inhibitor. However, no significant difference was noted between subjects who switched to a TNF inhibitor and those who received another type of biologic DMARD.

The present real-world population findings have concluded that switch to a second JAK inhibitors may be a promising therapeutic option in certain subset of RA patients.

 References: Amstad A, Papagiannoulis E, Scherer A, et al. Comparison of drug retention of TNF inhibitors, other biologics and JAK inhibitors in RA patients who discontinued JAK inhibitor therapy [published online ahead of print, 2022 May 17]. Rheumatology (Oxford). 2022;keac285