Drug retention of biologics and Janus kinase inhibitors in patients with rheumatoid arthritis: the ANSWER cohort study
Authors' conclusion
TNFi (HR=1.52, 95% CI: 1.37 to 1.68) and CTLA4-Ig (HR=1.14, 95% CI: 1.00 to 1.30) showed a higher overall drug discontinuation rate, excluding non-toxicity and remission, than aIL-6R.
Study context
- Population
- Real-world cohort of patients with RA, multicentre, Japan (ANSWER cohort)
- Participants
- 6,666 treatment courses
- Exposure
- Tumour necrosis factor inhibitors (TNFi), CTLA4-Ig and Janus kinase inhibitors (JAKi) vs aIL-6R
- TNFin = 3,577
- aIL-6Rn = 1,497reference
- CTLA4-Ign = 1,139
- JAKin = 453
- Outcome
- Drug retention; HRs of treatment discontinuation by reason (ineffectiveness, toxic adverse events, non-toxic reasons, remission)
Methodological detailsmulticentre, multivariate Cox proportional hazards modelling
- Multicentre
- Multivariate Cox proportional hazards modelling
Main finding
As reported in the abstract
Discontinuation due to ineffectiveness
Each group vs aIL-6RHazard ratio (95% CI)
TNFi
1.93(1.69–2.19)
CTLA4-Ig
1.42(1.20–1.67)
JAKi
1.29(1.03–1.63)
Observational data: associations, not effects.
Further findings
| Outcome | HR for overall drug discontinuation (95% CI) | |
|---|---|---|
| Overall drug discontinuation (excluding non-toxic reasons and remission)TNFivs aIL-6R | 1.52 (1.37–1.68) | |
| Overall drug discontinuation (excluding non-toxic reasons and remission)CTLA4-Igvs aIL-6R | 1.14 (1.00–1.30) | |
| 0.512HR for overall drug discontinuation (log scale) |
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Discontinuation due to toxic adverse eventsTNFivs CTLA4-Ig | 1.28 (1.05–1.56) | |
| Discontinuation due to toxic adverse eventsaIL-6Rvs CTLA4-Ig | 1.27 (1.03–1.57) | |
| Baseline oral GC use and discontinuation due to toxic adverse eventsJAKivs aIL-6RConcomitant oral GCs at baseline | 2.30 (1.23–4.28) | |
| Baseline oral GC use and discontinuation due to toxic adverse eventsTNFivs aIL-6RConcomitant oral GCs at baseline | 1.29 (1.07–1.55) | |
| 0.20.5125Hazard ratio (log scale) |
Original publication
Drug retention of biologics and Janus kinase inhibitors in patients with rheumatoid arthritis: the ANSWER cohort study. RMD Open. Published 18 August 2023. doi:10.
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