medwireNews: Real-world data from the JAKPOT study suggest slightly higher retention with Janus kinase (JAK) inhibitors than tumor necrosis factor (TNF) inhibitors in patients with rheumatoid arthritis (RA), but not significantly so due to rates varying widely from country to country.
“The objective of this study was to evaluate the effectiveness of JAK inhibitors compared to biologic DMARDs [in RA patients] in the real-world population using an international collaboration of registers,” Kim Lauper (University of Geneva, Switzerland) explained at the EULAR 2020 E-Congress.
A total of 17 registers were included, mostly from Europe, from which 25,521 patients were identified. Of these, 6063 initiated JAK inhibitors, 13,879 tumor necrosis factor (TNF) inhibitors, 2348 abatacept, and 3231 interleukin (IL)-6 inhibitors.
The mean age of the patients was 55 years and they had moderate disease activity with an average disease duration of 10.2 years. In all, 67.3% were seropositive.
Lauper noted that patients in the JAK inhibitor group were more often receiving monotherapy, had higher C-reactive protein levels, higher disease activity, and more often had a history of previous DMARD use than patients receiving the other treatments.
She reported that the median crude drug retention rates were around 1.1 years with abatacept, 1.4 years with IL-6 inhibitors, 1.3 years with JAK inhibitors, and 1.6 years with TNF inhibitors.
Adjusted discontinuation rates across the treatment were very “similar, maybe a bit lower with JAK inhibitors,” said Lauper. The adjusted hazard ratios, compared with TNF inhibitors, were about 1.0 for abatacept and IL-6 inhibitors and lower, at about 0.85, for JAK inhibitors, but the confidence interval was wide for JAK inhibitors, Lauper noted.
Across countries, however, there was a lot of heterogeneity in the adjusted hazard ratios for discontinuation, particularly for JAK inhibitors. Indeed, for JAK inhibitors, the heterogeneity was considerable, at an I2 of 94.7%, substantial for IL-6 inhibitors, at an I2 of 69.9%, and more moderate, at an I2 of 40.1%, for abatacept.
Lauper concluded: “The adjusted overall drug retention of JAK inhibitors tended to be higher than for TNF inhibitors, but not significantly.”
She added that the reasons for the heterogeneity between the registers will be part of the next steps in this research collaboration, along with looking at other measures of JAK inhibitor effectiveness, including the evaluation of CDAI remission and low disease activity, and evaluating safety.
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EULAR 2020 E-Congress; 3–6 June
Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-eular.346