Real-world comparative study of the efficacy of Janus kinase inhibitors in patients with rheumatoid arthritis: the ANSWER cohort study

Shinya Hayashi; Shotaro Tachibana; Toshihisa Maeda; Mai Yamashita; Iku Shirasugi; Yuzuru Yamamoto; Hirotaka Yamada; Takaichi Okano; Keisuke Nishimura; Yo Ueda; Sadao Jinnno; Jun Saegusa; Wataru Yamamoto; Koichi Murata; Takayuki Fujii; Kenichiro Hata; Ayaka Yoshikawa; Kosuke Ebina; Yuki Etani; Naofumi Yoshida; Hideki Amuro; Motomu Hashimoto; Ryota Hara; Masaki Katayama; Tadashi Okano; Ryosuke Kuroda

doi:10.1093/rheumatology/kead543

Real-world comparative study of the efficacy of Janus kinase inhibitors in patients with rheumatoid arthritis: the ANSWER cohort study

Rheumatology (Oxford). 2023 Nov 1:kead543. doi: 10.1093/rheumatology/kead543. Online ahead of print.

Authors

Shinya Hayashi¹, Shotaro Tachibana¹, Toshihisa Maeda¹, Mai Yamashita², Iku Shirasugi², Yuzuru Yamamoto², Hirotaka Yamada², Takaichi Okano², Keisuke Nishimura², Yo Ueda², Sadao Jinnno², Jun Saegusa², Wataru Yamamoto³, Koichi Murata⁴, Takayuki Fujii⁴, Kenichiro Hata⁵, Ayaka Yoshikawa⁵, Kosuke Ebina⁶, Yuki Etani⁷, Naofumi Yoshida^{8

9}, Hideki Amuro⁸, Motomu Hashimoto⁹, Ryota Hara¹⁰, Masaki Katayama¹¹, Tadashi Okano¹², Ryosuke Kuroda¹

Affiliations

¹ Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
² Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Japan.
³ Department of Health Information Management, Kurashiki Sweet Hospital, Kurashiki, Japan.
⁴ Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁵ Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical University, Osaka, Japan.
⁶ Department of Musculoskeletal Regenerative Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan.
⁷ Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
⁸ First Department of Internal Medicine, Kansai Medical University, Osaka, Japan.
⁹ Department of Clinical Immunology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
¹⁰ Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.
¹¹ Department of Rheumatology, Osaka Red Cross Hospital, Osaka, Japan.
¹² Department of Orthopedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.

PMID: 37924201
DOI: 10.1093/rheumatology/kead543

Abstract

Objective: This multicentre, retrospective study compared the efficacy and safety of tofacitinib, baricitinib, peficitinib and upadacitinib in real-world clinical settings after minimizing selection bias and adjusting the confounding patient characteristics.

Method: The 622 patients were selected from the ANSWER cohort database and treated with tofacitinib (TOF), baricitinib (BAR), peficitinib (PEF) or upadacitinib (UPA). The patient's background was matched using propensity score-based inverse probability of treatment weighting (IPTW) among four treatment groups. The values of Clinical Disease Activity Index (CDAI), C-reactive protein (CRP), and modified Health Assessment Questionnaire (mHAQ) after drug initiation and the remission or low disease activity (LDA) rates of CDAI at 6 months after drug initiation were compared among the four groups. Further, the predictive factor for TOF and BAR efficacy was analysed.

Results: The retention and discontinuation rates until 6 months after drug initiations were not significantly different among the four JAK inhibitors treatment groups. Mean CDAI value, CDAI remission rate, and CDAI-LDA rate at 6 months after drug initiation were not significantly different among treatment groups. Baseline CDAI (TOFA: OR 1.09, P < 0.001; BARI: OR 1.07, P < 0.001), baseline CRP (TOFA: OR 1.32, P = 0.049), baseline glucocorticoid dose (BARI: OR 1.18, 95% CI 1.01-1.38, P = 0.035), a number of previous biological or targeted synthetic disease-modifying antirheumatic drugs (biological/targeted synthetic DMARDs) (BARI: OR 1.36, P = 0.004) were predictive factors for resistance to CDAI-LDA achievement to JAK inhibitor treatment.

Conclusion: The efficacy and safety of TOF, BAR, PEF and UPA were not significantly different for the treatment of patients with rheumatoid arthritis.

Keywords: baricitinib; peficitinib; rheumatoid arthritis; tofacitinib; upadacitinib.