JAK inhibitors and bDMARDs show comparable effectiveness

JAK inhibitors show comparable effectiveness to biologic (b)DMARDs in rheumatoid arthritis (RA). That was the main conclusion of a comprehensive comparison between JAK inhibitors and bDMARD users in Swedish RA patients.

The oral administration and relatively low costs of JAK inhibitors are beneficial for RA patients. The first JAK inhibitors approved by the EMA, tofacitinib and baricitinib, have not been thoroughly compared with other biologics prescribed for RA. Therefore, Mr Andrei Barbulescu (Karolinska Institutet, Sweden) performed a comprehensive comparative analysis of JAK inhibitors and biological DMARDs. For the analysis, he used Swedish national data on RA clinical measurements from different registries. Mr Barbulescu compared patient characteristics, retention rates, and clinical responses of patients treated with JAK inhibitors or bDMARDs.

Patients on JAK inhibitors (n=905, mean age 60) started their treatment later in the disease than non-TNF inhibitor recipients (n=1,920) and patients treated with TNF inhibitors (n=3,497). The median RA duration in years at treatment initiation was 13 for JAK inhibitors and abatacept, 10 for IL-6 inhibitors, 12 for rituximab, and 9 for TNF inhibitors. At treatment initiation, the 28-joint disease activity score (DAS28) was generally lower in those treated with JAK inhibitors (4.6) and non-TNF inhibitors (abatacept 4.8; IL-6 inhibitors 4.9; rituximab 4.7) compared with those treated with TNF inhibitors (4.4). Combination therapy of JAK inhibitors and methotrexate was observed in 40% of the JAK inhibitor users. This is less frequent than in most bDMARD recipients, including methotrexate co-treatment with abatacept (49.8%), rituximab (52.8%), and TNF inhibitors (61.6%), but similar to co-treatment with IL-6 inhibitors (39.7%).

After adjustment for demographics, disease activity, previous use of targeted synthetic DMARDS or bDMARDs, disease history, and co-medication with glucocorticoids or methotrexate, no significant differences were found in treatment retention or treatment response at 12 months. However, IL-6 inhibitors trended towards a better treatment response on several outcome measures compared with JAK inhibitors. These included a good EULAR response (defined as DAS28 ≤3.2 plus a decrease of >1.2), in which an 8.7% difference was observed for IL-6 inhibitors versus JAK inhibitors (95% CI -1.5 to 18.9), and DAS28–ESR <2.6, in which IL-6 inhibitors differed 5.9% from JAK inhibitors (95% CI -5.9 to 17.18).

In addition, JAK inhibitors performed slightly better than TNF inhibitors on all treatment response outcomes, which were CDAI remission, joint counts remission, HAQ improvement, DAS28–ESR remission, and good EULAR response. In conclusion, bDMARDs and JAK inhibitors showed comparable effectiveness in this study.

1. Barbulescu A. Comparative effectiveness of JAKi versus bDMARD; a nationwide study in RA. OP0122, EULAR 2021 Virtual Congress, 2–5 June.

 

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Posted on 2 August 202131 January 2024