Real-world single centre use of JAK inhibitors across the rheumatoid arthritis pathway

Area of Science:

• Rheumatology
• Immunology
• Pharmacology

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation.
• Janus kinase (JAK) inhibitors, including tofacitinib and baricitinib, are approved treatments for RA.
• Understanding real-world effectiveness in diverse patient populations, including those refractory to other therapies, is crucial.

Purpose of the Study:

• To evaluate the real-world efficacy of tofacitinib and baricitinib in a large cohort of RA patients.
• To assess treatment outcomes across the entire patient pathway, including those with multiple prior biologic treatments.
• To compare the effectiveness of these JAK inhibitors in different patient subgroups.

Main Methods:

• Retrospective analysis of 115 RA patients treated with tofacitinib or baricitinib since 2017.
• Disease Activity Score 28-C-reactive protein (DAS28-CRP) recorded at baseline, 3, and 6 months.
• Efficacy evaluated in the total cohort and subgroups based on prior biologic disease-modifying antirheumatic drug (bDMARD) exposure.

Main Results:

• A significant improvement in DAS28-CRP was observed at 3 and 6 months in the combined JAK inhibitor group (mean improvement of 1.49 and 1.67, respectively).
• Effectiveness was comparable between tofacitinib and baricitinib groups and notable in biologic-naïve patients and those refractory to multiple bDMARDs.
• Twelve patients previously unresponsive to IL-6 blockade showed a response to JAK inhibitors; two cases of venous thromboembolism were noted.

Conclusions:

• Janus kinase (JAK) inhibition demonstrates effectiveness in a real-world RA patient population.
• These findings support the use of JAK inhibitors in RA patients, including those with resistance to multiple prior bDMARDs.
• Further research into long-term outcomes and safety profiles is warranted.