The real-world ANSWER cohort study underscores the comparable efficacy of JAK inhibitors in managing rheumatoid arthritis

The efficacy and safety of JAK inhibitors in randomized controlled trials have been demonstrated, but certain researchers have indicated concerns regarding their potential efficacy in the treatment of rheumatoid arthritis (RA). A new paper published in Rheumatology by Oxford University Press suggests that Janus kinase (JAK) inhibitors, are effective in the treatment of RA.

Hayashi and colleagues conducted a retrospective, multicenter study that revealed that the JAK inhibitor drugs have a positive effect on remission rates in patients, most of whom continued the treatment.

In this particular study, 622 patients were chosen from the ANSWER cohort database. They were treated with either tofacitinib (TOF), baricitinib (BAR), peficitinib (PEF) or upadacitinib (UPA). To ensure objectivity, the patient’s background was matched using propensity score-based inverse probability of treatment weighting (IPTW) across the four treatment groups. The researchers compared the values of the Clinical Disease Activity Index (CDAI), C-reactive protein (CRP), and modified Health Assessment Questionnaire (mHAQ) after drug initiation, as well as the rates of remission or low disease activity (LDA) of CDAI at 6 months after drug initiation among the four groups. Additionally, they analyzed the predictive factor for TOF and BAR efficacy.

The rates of retention and discontinuation up to 6 months after starting drug treatment were not significantly different among the four groups receiving JAK inhibitors. Biological disease-modifying drugs are commonly used to achieve low disease activity (LDA) and remission. This study shows that JAK inhibitors can also provide a more convenient and effective option for RA patients.

Similarly, Temmoku et al. conducted a comparative study to analyze the drug retention rates and effectiveness of biologic disease-modifying antirheumatic drugs (bDMARDs) and JAK inhibitors in elderly patients with RA. The study revealed that there was no significant difference in overall drug retention rates between bDMARDs and JAK inhibitors. Moreover, the treatment effectiveness was found to be similar for elderly RA patients who were initiated with bDMARDs or JAK inhibitors.

A retrospective study by Liao and colleagues found that the efficacy and safety of BAR and TOF treatments were similar in patients with RA. However, BAR was more effective in relieving pain than TOF. The study also noted that elderly RA patients receiving BAR treatment were more likely to achieve LDA, while those with a low baseline erythrocyte sedimentation rate (ESR) were more likely to achieve LDA following TOF treatment.

The study findings recommend JAK inhibitors as a convenient and effective option for RA patients, with comparable safety and efficacy profile as that of DMARDs. The studies also highlight the evolving landscape of treatments for RA and emphasize the need for tailoring therapies as per the patient requirements.

References

  1. Hayashi S, Tachibana S, Maeda T, Yamashita M, Shirasugi I, Yamamoto Y, et al. Real-world comparative study of the efficacy of Janus kinase inhibitors in patients with rheumatoid arthritis: the ANSWER cohort study. Rheumatology. 2023 Nov 1;kead543.
  2. Temmoku J, Migita K, Yoshida S, Matsumoto H, Fujita Y, Matsuoka N, et al. Real-world comparative effectiveness of bDMARDs and JAK inhibitors in elderly patients with rheumatoid arthritis. Medicine (Baltimore). 2022 Oct 21;101(42): e31161.
  3. Liao X, Huo W, Zeng W, Qin F, Dong F, Wei W, et al. Efficacy and safety of different Janus kinase inhibitors combined with methotrexate for the treatment of rheumatoid arthritis: a single-center randomized trial. Advances in Rheumatology. 2023 Oct 16;63(1):50.
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