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Hernández-Cruz B, Otero-Varela L, Freire-González M, Busquets-Pérez N, García González AJ, Moreno-Ramos M, Blanco-Madrigal JM, Manrique-Arija S, Perez-Pampin E, Ruiz-Montesino D, Sánchez-Alonso F, Sanchez-Piedra C, Castrejón I. Janus kinase inhibitors and tumour necrosis factor inhibitors show a favourable safety profile and similar persistence in rheumatoid arthritis, psoriatic arthritis and spondyloarthritis: real-world data from the BIOBADASER registry. Ann Rheum Dis 2024:ard-2023-225271. [PMID: 38594056 DOI: 10.1136/ard-2023-225271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To compare the safety of Janus kinase inhibitors (JAKi) with that of tumour necrosis factor inhibitors (TNFi) and determine drug persistence among patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). METHODS We analysed data from patients included in BIOBADASER 3.0 and treated with JAKi or TNFi from 2015 to 2023 and estimated the incidence rate ratio (IRR) of adverse events and persistence. RESULTS A total of 6826 patients were included. Of these, 52% had RA, 25% psoriatic arthritis and 23% axial SpA. Treatment was with TNFi in 86%. The mean duration of treatment was 2.2±2.0 years with TNFi versus 1.8±1.5 with JAKi. JAKis were prescribed in older patients with longer term disease, greater comorbidity and later treatment lines and more frequently as monotherapy. The IRR of all infections and gastrointestinal events was higher among patients with RA treated with JAKi. Drug persistence at 1, 2 and 3 years was 69%, 55% and 45% for TNFi and 68%, 54% and 45% for JAKi. Multivariate regression models showed a lower probability of discontinuation for JAKi (HR=0.85; 95% CI 0.78-0.92) and concomitant conventional synthetic disease-modifying antirheumatic drugs (HR=0.90; 95% CI 0.84-0.96). The risk of discontinuation increased with glucocorticoids, comorbidities, greater disease activity and later treatment lines. CONCLUSIONS Infections, herpes zoster and gastrointestinal adverse events in patients with RA tended to be more frequent with JAKi. However, prognosis was poor in patients receiving JAKi. Persistence was similar for TNFi and JAKi, although factors associated with discontinuation differed by diagnostic group.
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Affiliation(s)
| | | | | | | | | | | | | | - Sara Manrique-Arija
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Hospital Regional Universitario de Málaga, UGC de Reumatología, Málaga, Spain
- Departamento de Medicina, Universidad de Málaga, Málaga, Spain
| | - Eva Perez-Pampin
- Department of Rheumatology, Hospital Clinico Universitario Santiago de Compostela, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | - Isabel Castrejón
- Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigacion Sanitaria Gregorio Marañón, Madrid, Spain
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