Effectiveness of JAK inhibitors in biologics-naïve patients with RA: a population-based study

We evaluated drug retention rates to compare the effectiveness of Janus kinase (JAK) inhibitors vs TNF inhibitor (TNFi) biologics and non-TNFi biologics in biologics-naïve RA patients, and assessed intra-class differences among JAK inhibitors.

We conducted a cohort study using Taiwan's National Health Insurance Research Database, including RA patients initiating TNFi biologics, non-TNFi biologics or JAK inhibitors. We followed patients from index date until outcome, death or end of 2-year study period. To evaluate retention rate, we used treatment change defined as discontinuation or switching of medications. We calculated hazard ratios of treatment change to compare the effectiveness of JAK inhibitors vs biologics, using JAK inhibitors as reference group.

Of 16 212 patients, 2654 (16.37%) received JAK inhibitors, 10 080 (62.18%) received TNFi biologics, and 3478 (21.45%) received non-TNFi biologics. We found TNFi biologics were associated with a higher risk of treatment change than JAK inhibitors (hazard ratio = 1.38; 95% CI: 1.25-1.53). We found no significant difference between JAK inhibitors and non-TNFi biologics. The risk of treatment change among JAK inhibitors (tofacitinib, baricitinib) was similar.

Our findings reflected drug effectiveness by the duration that patients maintained the regimen, considering both therapeutic effects and adverse events. We found JAK inhibitors had better effectiveness than TNFi biologics, with no significant difference compared with non-TNFi biologics in biologics-naïve patients. Intra-class comparison of JAK inhibitors indicated similar effectiveness for both tofacitinib and baricitinib. These findings supported the use of JAK inhibitors in RA patients after failure of conventional DMARDs treatment.