Rheumatology Unit, Azienda Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
Division of Rheumatology, Department of Medicine (DAME), University of Udine, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy.
Clin Exp Rheumatol. 2024 Jul;42(7):1416-1420. doi: 10.55563/clinexprheumatol/za0hpu. Epub 2024 Mar 26.
We aimed to retrospectively evaluate retention rate and causes of discontinuation of JAKi in rheumatoid arthritis (RA) patients with particular regards to difficult-to-treat subgroups.
The diffusion of Janus kinase inhibitors (JAKi) for the treatment of RA has rapidly increased in recent years due to their effectiveness, even in difficult-to-treat subgroups of patients. After the publication of the Oral Surveillance study, the labelling of JAKi was modified, advising against their use in elderly patients and those at risk for cardiovascular events and malignancies. Demographic, clinical, serological and therapeutic characteristics of RA patients treated with JAKi were recorded, including smoking habit and comorbidities.
Three hundred and thirty consecutive RA patients were enrolled in the study. Among them, 50.3% patients had previously failed at least two biologic DMARDs. Risk factors for the use of JAKi were reported in 75.5% of patients, 41.5% of them were older than 65 years, 37.6% had smoked, while 48.8% had increased cardiovascular or cancer risk. Anticitrullinated peptide antibodies (ACPA) and combination therapy with conventional synthetic DMARDs were associated with a longer drug persistence and ACPA remained independently associated to a higher retention rate of JAKi also in the subgroup of difficult-to-treat patients.
In conclusion, our study supports the clinical effectiveness of JAKi in RA, even in the multi-failure subgroup of patients, where the risk/benefit ratio overcomes the safety risk. The presence of ACPA and the concurrent use of + cs-DMARD may increase the survival on JAKi in the long term.
我们旨在回顾性评估类风湿关节炎（RA）患者接受 JAKi 治疗的保留率和停药原因，尤其关注治疗困难亚组。
近年来，由于 JAKi 的有效性，即使在治疗困难的患者亚组中，其用于治疗 RA 的应用也迅速普及。在 Oral Surveillance 研究发表后，JAKi 的标签被修改，建议避免在老年患者以及有心血管事件和恶性肿瘤风险的患者中使用。记录了接受 JAKi 治疗的 RA 患者的人口统计学、临床、血清学和治疗特征，包括吸烟习惯和合并症。
本研究共纳入 330 例连续 RA 患者。其中，50.3%的患者之前至少失败过两种生物 DMARD。75.5%的患者报告了使用 JAKi 的风险因素，其中 41.5%的患者年龄大于 65 岁，37.6%的患者吸烟，而 48.8%的患者有增加的心血管或癌症风险。抗瓜氨酸肽抗体（ACPA）和常规合成 DMARD 联合治疗与药物持续时间延长相关，ACPA 仍然与 JAKi 的保留率更高相关，即使在治疗困难的患者亚组中也是如此。
总之，我们的研究支持 JAKi 在 RA 中的临床疗效，即使在多线治疗失败的患者亚组中，风险/效益比超过了安全性风险。ACPA 的存在和同时使用 cs-DMARD 可能会增加 JAKi 的长期生存率。
