Comparative effectiveness and safety of five Janus kinase inhibitors in real-world clinical practice: the multicentre ANSWER cohort
Authors' conclusion
Treatment effectiveness and safety differed among JAKi in real-world clinical practice. Upadacitinib and filgotinib were associated with higher treatment persistence, and the adverse impact of prior IL-6 inhibitor or JAKi exposure was not evident for these agents.
Study context
- Population
- Rheumatoid arthritis (RA) treatment courses initiating tofacitinib, baricitinib, peficitinib, upadacitinib, or filgotinib between 2013 and 2025, ANSWER cohort in Japantreatment courses from 1,240 patients
- Participants
- 1,798 participants
- Exposure
- Five Janus kinase inhibitors (JAKi) compared for treatment effectiveness and safety
- Outcome
- Treatment discontinuation due to ineffectiveness
Methodological detailsmultivariable Cox proportional hazards models with multiple imputation, Kaplan-Meier analysis, adjusted for patient, disease, and treatment characteristics, including prior treatment history
- Multivariable Cox proportional hazards models with multiple imputation
- Kaplan-Meier analysis
- Adjusted for patient, disease, and treatment characteristics, including prior treatment history
Main finding
As reported in the abstract
Each group vs TOFACITINIBHazard ratio (95% CI)
UPADACITINIB
0.33(0.24–0.47)
FILGOTINIB
0.59(0.42–0.85)
BARICITINIB
0.82(0.63–1.06)
PEFICITINIB
1.23(0.89–1.70)
Observational data: associations, not effects.
Further findings
Ineffectiveness-related discontinuation with prior IL-6i or JAKi use (subgroup)
| HR (95% CI) | ||
|---|---|---|
| Prior IL-6i use (upadacitinib) | 0.67 (0.38–1.16) | |
| Prior JAKi use (upadacitinib) | 1.14 (0.65–1.98) | |
| Prior IL-6i use (filgotinib) | 0.83 (0.45–1.53) | |
| Prior JAKi use (filgotinib) | 1.38 (0.72–2.65) | |
| 0.20.5125Hazard ratio (log scale) |
- Prior IL-6i or JAKi use increased ineffectiveness-related discontinuation for tofacitinib, baricitinib, and peficitinib
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Treatment discontinuation due to adverse eventsUPADACITINIBvs PEFICITINIB | 0.57 (0.38–0.85) | |
| 0.20.5125Hazard ratio (log scale) |
- Treatment discontinuation due to adverse events: differences observed only between upadacitinib and peficitinib
Original publication
Comparative effectiveness and safety of five Janus kinase inhibitors in real-world clinical practice: the multicentre ANSWER cohort. Rheumatology (Oxford). Published 28 October 2026. doi:10.
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