Factors associated with selection of targeted therapy in patients with rheumatoid arthritis

Area of Science:

• Rheumatology
• Pharmacology
• Clinical Medicine

Background:

• Rheumatoid arthritis (RA) requires careful selection of targeted therapies.
• Janus kinase inhibitors (JAKis) and biologic disease-modifying antirheumatic drugs (bDMARDs) are key treatment options.
• Understanding factors influencing the choice between JAKis and bDMARDs is crucial for optimizing RA management.

Purpose of the Study:

• To identify factors associated with selecting Janus kinase inhibitors (JAKis) over biologic disease-modifying antirheumatic drugs (bDMARDs) in rheumatoid arthritis (RA) patients.
• To provide insights into real-world clinical decision-making for RA targeted therapy in Korea.

Main Methods:

• Prospective cohort study of RA patients initiating JAKis or bDMARDs in a single Korean center.
• Patients categorized into JAKi, TNF inhibitor, and non-TNF inhibitor groups.
• Multinomial logistic regression analysis to determine factors influencing JAKi selection.

Main Results:

• Older age was associated with JAKi selection compared to TNF inhibitors, but younger than non-TNF inhibitors.
• Lower likelihood of chronic pulmonary disease in the JAKi group compared to both bDMARD groups.
• Higher physician-assessed disease activity and prior tacrolimus use significantly predicted JAKi selection over TNF inhibitors.

Conclusions:

• Age, pulmonary comorbidities, previous tacrolimus use, and high disease activity are key factors in choosing JAKis for RA patients in Korea.
• These findings aid clinicians in tailoring sequential targeted therapy for RA.
• Real-world data highlights specific patient characteristics influencing the selection of JAKis versus bDMARDs.