TY - JOUR
T1 - Effectiveness of TNF-inhibitors, abatacept, IL6-inhibitors and JAK-inhibitors in 31 846 patients with rheumatoid arthritis in 19 registers from the 'JAK-pot' collaboration
AU - Lauper, Kim
AU - Ludici, Michele
AU - Mongin, Denis
AU - Bergstra, Sytske Anne
AU - Choquette, Denis
AU - Codreanu, Catalin
AU - Cordtz, René
AU - De Cock, Diederik
AU - Dreyer, Lene
AU - Elkayam, Ori
AU - Hauge, Ellen-Margrethe
AU - Huschek, Doreen
AU - Hyrich, Kimme L
AU - Iannone, Florenzo
AU - Inanc, Nevsun
AU - Kearsley-Fleet, Lianne
AU - Kristianslund, Eirik Klami
AU - Kvien, Tore K
AU - Leeb, Burkhard F
AU - Lukina, Galina
AU - Nordström, Dan C
AU - Pavelka, Karel
AU - Pombo-Suarez, Manuel
AU - Rotar, Ziga
AU - Santos, Maria Jose
AU - Strangfeld, Anja
AU - Verschueren, Patrick
AU - Courvoisier, Delphine Sophie
AU - Finckh, Axel
N1 - © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/10
Y1 - 2022/10
N2 - BACKGROUND: JAK-inhibitors (JAKi), recently approved in rheumatoid arthritis (RA), have changed the landscape of treatment choices. We aimed to compare the effectiveness of four current second-line therapies of RA with different modes of action, since JAKi approval, in an international collaboration of 19 registers.METHODS: In this observational cohort study, patients initiating tumour necrosis factor inhibitors (TNFi), interleukin-6 inhibitors (IL-6i), abatacept (ABA) or JAKi were included. We compared the effectiveness of these treatments in terms of drug discontinuation and Clinical Disease Activity Index (CDAI) response rates at 1 year. Analyses were adjusted for patient, disease and treatment characteristics, including lines of therapy and accounted for competing risk.RESULTS: We included 31 846 treatment courses: 17 522 TNFi, 2775 ABA, 3863 IL-6i and 7686 JAKi. Adjusted analyses of overall discontinuation were similar across all treatments. The main single reason of stopping treatment was ineffectiveness. Compared with TNFi, JAKi were less often discontinued for ineffectiveness (adjusted HR (aHR) 0.75, 95% CI 0.67 to 0.83), as was IL-6i (aHR 0.76, 95% CI 0.67 to 0.85) and more often for adverse events (aHR 1.16, 95% CI 1.03 to 1.33). Adjusted CDAI response rates at 1 year were similar between TNFi, JAKi and IL-6i and slightly lower for ABA.CONCLUSION: The adjusted overall drug discontinuation and 1 year response rates of JAKi and IL-6i were similar to those observed with TNFi. Compared with TNFi, JAKi were more often discontinued for adverse events and less for ineffectiveness, as were IL-6i.
AB - BACKGROUND: JAK-inhibitors (JAKi), recently approved in rheumatoid arthritis (RA), have changed the landscape of treatment choices. We aimed to compare the effectiveness of four current second-line therapies of RA with different modes of action, since JAKi approval, in an international collaboration of 19 registers.METHODS: In this observational cohort study, patients initiating tumour necrosis factor inhibitors (TNFi), interleukin-6 inhibitors (IL-6i), abatacept (ABA) or JAKi were included. We compared the effectiveness of these treatments in terms of drug discontinuation and Clinical Disease Activity Index (CDAI) response rates at 1 year. Analyses were adjusted for patient, disease and treatment characteristics, including lines of therapy and accounted for competing risk.RESULTS: We included 31 846 treatment courses: 17 522 TNFi, 2775 ABA, 3863 IL-6i and 7686 JAKi. Adjusted analyses of overall discontinuation were similar across all treatments. The main single reason of stopping treatment was ineffectiveness. Compared with TNFi, JAKi were less often discontinued for ineffectiveness (adjusted HR (aHR) 0.75, 95% CI 0.67 to 0.83), as was IL-6i (aHR 0.76, 95% CI 0.67 to 0.85) and more often for adverse events (aHR 1.16, 95% CI 1.03 to 1.33). Adjusted CDAI response rates at 1 year were similar between TNFi, JAKi and IL-6i and slightly lower for ABA.CONCLUSION: The adjusted overall drug discontinuation and 1 year response rates of JAKi and IL-6i were similar to those observed with TNFi. Compared with TNFi, JAKi were more often discontinued for adverse events and less for ineffectiveness, as were IL-6i.
KW - Arthritis
KW - Biological Therapy
KW - Epidemiology
KW - Rheumatoid
KW - Therapeutics
KW - Tumor Necrosis Factor Inhibitors
UR - http://www.scopus.com/inward/record.url?scp=85132553209&partnerID=8YFLogxK
U2 - 10.1136/annrheumdis-2022-222586
DO - 10.1136/annrheumdis-2022-222586
M3 - Journal article
C2 - 35705376
SN - 0003-4967
VL - 81
SP - 1358
EP - 1366
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 10
M1 - 222586
ER -