Baseline neutrophil-to-lymphocyte ratio predicts drug retention of IL-6 inhibitors and JAK inhibitors in RA: the ANSWER cohort study
Authors' conclusion
In patients with elevated baseline NLR values, aIL-6R and JAKi may offer superior drug retention compared with TNFi when initiating b/tsDMARD therapy.
Study context
- Population
- Patients with RA with moderate to high disease activity initiating b/tsDMARDs, Kansai Multicentre ANSWER cohort; NLRlow vs NLRhigh by median neutrophil-to-lymphocyte ratio (NLR) 3.30
- Participants
- 774 treatment courses
- Exposure
- Tumour necrosis factor inhibitors (TNFi) vs aIL-6R vs CTLA4-Ig vs Janus kinase inhibitors (JAKi), stratified by baseline NLR
- Outcome
- Drug retention
- Follow-up
- 2 years
Methodological detailsmulticentre, multivariate Cox proportional hazards model adjusted for potential confounders
- Multicentre
- Multivariate Cox proportional hazards model adjusted for potential confounders
Main finding
As reported in the abstract
Drug retention, NLRhigh subgroup
Each group vs TNFiHazard ratio (95% CI)
aIL-6R
0.53(0.32–0.88)
JAKi
0.36(0.20–0.64)
Observational data: associations, not effects.
Further findings
Baseline characteristics, NLRhigh vs NLRlow
- Higher baseline Clinical Disease Activity Index (CDAI) in NLRhigh
- P = 0.004
- More frequent GC use in NLRhigh
- P < 0.001
CDAI · 12 months
- CDAI did not significantly differ among the four treatment groups in either NLR group
Original publication
Baseline neutrophil-to-lymphocyte ratio predicts drug retention of IL-6 inhibitors and JAK inhibitors in RA: the ANSWER cohort study. Rheumatology (Oxford). Published 10 November 2025. doi:10.
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