Comparison of tofacitinib, baricitinib, upadacitinib and filgotinib: a 2-year observational study from FIRST registry
Authors' conclusion
This real-world study found no clinically meaningful differences in 2-year effectiveness among four JAKis, although the study was not powerful enough to detect differences in safety.
Study context
- Population
- Patients with rheumatoid arthritis (RA) treated with Janus kinase inhibitors (JAKis) in real-world settings, FIRST registry
- Participants
- 607 treatment courses
- Exposure
- Four JAKis compared: Tofacitinib (TOF) vs baricitinib (BAR) vs upadacitinib (UPA) vs filgotinib (FIL)
- TOFn = 159
- BARn = 262
- UPAn = 122
- FILn = 64
- Outcome
- Change in CDAI score
- Follow-up
- Year 2
Methodological detailsmulticentre registry, multivariable mixed-effects models adjusted for baseline characteristics
- Multicentre registry
- Multivariable mixed-effects models adjusted for baseline characteristics
Main finding
As reported in the abstract
Change in CDAI
- Multivariable analysis: no significant differences in Clinical Disease Activity Index (CDAI) among the four JAKis
- As-observed analysis: slower improvement in UPA and FIL
Observational data: associations, not effects.
Secondary outcomes
Patient-reported outcomes (PROs)
- Multivariable analysis: no significant differences in PROs
CDAI components (tender joint count, evaluator's global assessment)
- UPA showed greater improvement in tender joint count and evaluator's global assessment
Overall retention rate · 2 years
- 2-year overall retention rate
- 78%
Discontinuation for insufficient effectiveness (most common reason)
- Rate
- 6.5/100 person-years
Safety
Discontinuation for adverse events
- Rate
- 4.2/100 py
- Study not powerful enough to detect differences in safety
Original publication
Comparison of tofacitinib, baricitinib, upadacitinib and filgotinib: a 2-year observational study from FIRST registry. RMD Open. Published 16 January 2026. doi:10.
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