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Drug Retention Rates of Janus Kinase Inhibitors in Rheumatoid Arthritis Patients with Therapy-Induced Lymphopenia

Jumpei Temmoku1, Masayuki Miyata2, Eiji Suzuki3

  • 1Department of Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima 960-1295, Fukushima, Japan.

Journal of Clinical Medicine
|July 29, 2023
PubMed
Abstract

Insights

Lymphocytopenia in rheumatoid arthritis patients treated with tofacitinib is linked to lower drug retention due to adverse events. This association was not observed with baricitinib, suggesting drug-specific effects.

Area of Science:

  • Rheumatology
  • Pharmacology
  • Immunology

Background:

  • Rheumatoid arthritis (RA) is a chronic autoimmune disease.
  • Janus kinase inhibitors (JAKi) like tofacitinib and baricitinib are used to treat RA.
  • Drug-induced lymphocytopenia is a potential side effect of JAKi therapy.

Purpose of the Study:

  • To investigate the relationship between drug-induced lymphocytopenia and drug retention rates of tofacitinib and baricitinib in RA patients.
  • To determine if early-phase lymphocytopenia impacts long-term treatment adherence.

Main Methods:

  • Retrospective analysis of 112 RA patients treated with tofacitinib or baricitinib for at least 4 months.
  • Monitoring of absolute lymphocyte counts (ALC) pre-treatment and monthly for up to 4 months.
  • Association analysis between ALC nadir and drug retention rates.

Main Results:

  • Lymphocytopenia occurred in approximately 25% of RA patients treated with JAKi.
  • RA patients experiencing lymphocytopenia showed lower retention rates for tofacitinib, primarily due to adverse event-related discontinuation.
  • Lymphocytopenia was not associated with reduced drug retention for baricitinib.
  • Pre-treatment lymphocyte counts did not predict JAKi drug retention.

Conclusions:

  • Early-onset lymphocytopenia (within 4 months) is associated with decreased drug retention in RA patients treated with JAKi.
  • This association is specific to tofacitinib and linked to adverse events.
  • Findings highlight the need for monitoring lymphocyte counts during tofacitinib therapy in RA.
Keywords:
Janus kinase inhibitordrug retention ratelymphopeniarheumatoid arthritis

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