Switching to biological DMARDs versus cycling among JAK inhibitors in patients with rheumatoid arthritis and with inadequate response to JAK inhibitors: from FIRST registry
Authors' conclusion
Cycling JAKis is more effective than switching to bDMARDs in JAKi-IR RA, with no differences in safety or retention.
Study context
- Population
- Patients with rheumatoid arthritis (RA) who started JAKi treatment; Janus kinase inhibitors (JAKi-IR) = switched due to inadequate response or did not reach low disease activity within 26 weeks138 JAKi-IR
- Participants
- 434 patients
- Exposure
- Cycling to another JAKi vs switching to biological disease-modifying anti-rheumatic drugs (bDMARDs) in JAKi-IR RA
- JAKi cyclingn = 31
- bDMARDsn = 45reference
- Outcome
- Efficacy and safety of subsequent treatment (CDAI) after switching in JAKi-IR patients
- Follow-up
- 26 weeks after switching
Methodological detailsFIRST registry, multiple logistic regression, trajectory analysis
- FIRST registry
- Multiple logistic regression
- Trajectory analysis
Main finding
As reported in the abstract
CDAI after switching treatment · week 26
- Among those cycling to another JAKi, Clinical Disease Activity Index (CDAI) scores improved by week 26, with higher remission rates
Observational data: associations, not effects.
Further findings
JAKi-IR prevalence
- Patients with JAKi-IR RA
- 31.8% (n=138/434)
- Factors contributing to JAKi-IR: prior use of multiple ineffective bDMARDs and suboptimal JAKi dosing
- Multiple logistic regression
Retention
- Retention remained similar
CDAI trajectory analysis
- Three CDAI response patterns; 'treatment response' group showed rapid and sustained improvement when cycling to another JAKi; another JAKi cycle the critical factor for treatment response
Safety
- Adverse events remained similar
Original publication
Switching to biological DMARDs versus cycling among JAK inhibitors in patients with rheumatoid arthritis and with inadequate response to JAK inhibitors: from FIRST registry. RMD Open. Published 21 January 2025. doi:10.
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