Journal
ANNALS OF THE RHEUMATIC DISEASES
Volume 81, Issue 10, Pages 1358-1366Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/annrheumdis-2022-222586
Keywords
Epidemiology; Biological Therapy; Tumor Necrosis Factor Inhibitors; Arthritis; Rheumatoid; Therapeutics
Categories
Funding
- Ministry of Health for conceptual development of research organisation [MZ00023728023728]
- Fundacion Espanola de Reumatologia
- Spanish Medicines and Health Products Agency (Agencia Espanola del Medicamento y Productos Sanitarios)
- AbbVie
- BMS
- Celltrion
- Galapagos
- Janssen
- Lilly
- MSD
- Novartis
- Pfizer
- Regeneron
- Roche
- Samsung
- Schering-Plough
- UCB
- Medis
- Biogen
- Amgen
- Sanofi
- Celgene
- British Society for Rheumatology (BSR)
- Celltrion HC
- Eli Lilly
- Samsung Bioepis
- Sandoz
- BSR
- The University of Manchester
- National Institute for Health Research
- BSRBR--RA Control Centre Consortium
- Bristol Myers Squibb
- Fresenius Kabi
- Hexal
- Viatris
- Sanofi--Aventis
- Hospira
- Ewopharma
- Nopvartis MSD
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This study compared the effectiveness of four different second-line therapies of rheumatoid arthritis and found that the overall drug discontinuation and 1-year response rates of JAKi and IL-6i were similar to TNFi. JAKi were more often discontinued for adverse events and less for ineffectiveness compared to TNFi.
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.
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