TARDIS-RA suggests choosing IL-6 inhibitors after JAK inhibitor failure

Data from the TARDIS-RA registry indicates that IL-6 inhibitors may be the preferred therapeutic option after cessation of JAK inhibitor therapy in patients with rheumatoid arthritis (RA). Compared with other advanced therapies, this drug class improved short-term clinical responses in bio-naïve and bio-experienced patients [1].

With the introduction of JAK inhibitors to the field of rheumatology, the question has been raised about which mechanism of action should be selected after the cessation of JAK inhibitors in patients with RA. Thus far, evidence suggests that cycling JAK inhibitors or switching to a bDMARD are equally effective [2]. Dr Diederik De Cock (KU Leuven, Belgium) and co-investigators aimed to assess the clinical responses to various advanced therapies in patients with RA who stopped JAK inhibitor therapy. For this purpose, 1,238 patients from the TARDIS-RA registry in whom JAK inhibitor treatment had failed and who initiated a subsequent therapy were included in the study. However, only 577 patients were analysed for their clinical response because patients on rituximab were excluded from the analysis. Change in Disease Activity Score-28 (DAS28) after 3-6 months was the main outcome of the study.

Patients who switched from a JAK inhibitor to an IL-6 inhibitor achieved a larger change in DAS28 (mean -2.4) than those who switched to TNF inhibitors (-1.7), B/T-cell therapy (-1.6), or cycled JAK inhibitors (-1.3; P<0.001). Similarly, remission rates were higher in patients who switched to IL-6 inhibitors (56%) compared with those who switched to TNF inhibitors (42%), B/T-cell therapy (41%), or cycled JAK inhibitors (39%; P=0.045). Both findings were numerically apparent in bio-naïve and bio-experienced patients. “DAS28-erythrocyte sedimentation rate scores confirmed the results of DAS28-C-reactive protein scores,” added Dr De Cock.

“Although switching to IL-6 inhibitors appeared to instigate an improved short-term clinical response after stopping JAK inhibitor therapy compared with switching to other agents or cycling JAK inhibitors, differences in baseline demographic and clinical variables may have influenced the results,” outlined Dr De Cock.

1. De Cock D, et al. What treatment gives the best clinical response after cessation of JAKi therapy in patients with RA? Data of the TARDIS-RA registry, a nationwide Belgian Biologic registry. Abstract A16, BCR 2022, 21-23 Sep, Mons, Belgium.
2. Pombo-Suarez M, et al. 2022;annrheumdis-2022-222835.

 

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Posted on 23 September 202210 October 2022