medwireNews: People with rheumatoid arthritis (RA) who switch from one Janus kinase (JAK) inhibitor to another following initial discontinuation have a higher drug retention rate than if they switch to a tumor necrosis factor (TNF) inhibitor instead, Swiss research suggests.
The prospective observational study included data for 400 JAK inhibitor treatment courses among 364 patients from the Swiss RA registry SCQM who subsequently switched to either another JAK inhibitor, a TNF inhibitor, or a biologic DMARD with another mode of action in 2013–2020.
The most commonly used initial JAK inhibitor was tofacitinib (83.2%) followed by baricitinib (16.5%) and upadacitinib (0.2%). Initial treatment was discontinued after a median of 232 days; approximately a fifth (20.2%) of the initial treatments were switched to another JAK inhibitor, 31.3% were switched to a TNF inhibitor, and the remaining 48.5% were switched to another biologic DMARD.
Reasons given by the treating rheumatologist for discontinuation included lack of effectiveness (57.2%) and adverse events (27.8%).
Diego Kyburz (University Hospital Basel) and co-investigators report in Rheumatology that, following the switch, median drug retention times were 918 days, 335 days, and 508 days in the JAK inhibitor, TNF inhibitor, and other biologic DMARD groups, respectively, with the difference between the groups being statistically significant.
After adjustment for potential confounders, the researchers observed that the risk for drug discontinuation was a significant 52% lower among patients who switched to another JAK inhibitor relative to those who switched to a TNF inhibitor. There was no significant difference, however, between the people who switched to a TNF inhibitor and those who were given another type of biologic DMARD.
Kyburz et al conclude: “The results of our study indicate that switching to another JAK [inhibitor] is an effective therapeutic option in patients who discontinued JAK [inhibitors] and may be preferable over TNF [inhibitors] in patients who failed several previous [biologic] DMARD treatments.”
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