Anno Shohei, Okano Tadashi, Mamoto Kenji, Yamada Yutaro, Mandai Koji, Orita Kazuki, Iida Takahiro, Tada Masahiro, Inui Kentaro, Koike Tatsuya, Nakamura Hiroaki
Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan.
Center for Senile Degenerative Disorders (CSDD), Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Mod Rheumatol. 2025 Feb 21;35(2):225-233. doi: 10.1093/mr/roae077.
This study evaluated the effectiveness of Janus kinase inhibitors (JAKi) in patients with difficult-to-treat rheumatoid arthritis (D2T RA).
This study included 220 patients with RA who were treated with JAKi. Sixty-two patients were naïve to biological disease-modifying antirheumatic drugs (bDMARDs)/JAKi (1st group), 57 patients were failure to one bDMARDs/JAKi (2nd group), and 101 patients were failure to ≥ 2 bDMARDs/JAKi. Of these 101 patients, 25 did not meet the D2T RA criteria (non-D2T RA group) and 76 met the D2T RA criteria (D2T RA group).
: DAS28-ESR was improved in all groups at 24 weeks (1st: P < .01, 2nd: P < .01, non-D2T RA: P = .01, D2TRA: P = .02), and improvement ratio of DAS28-ESR was not different between DT2RA group and 2nd (P = .73) or non-D2T RA group (P = .68). Glucocorticoid use [odds ratios: 8.67; 95% confidence interval (CI): 1.23-60.90; P = .03] and number of past bDMARD/JAKi uses ≥ 3 (odds ratios: 10.55; 95% CI: 1.39-80.30; P = .02) were risk factors for DAS28-ESR ≥ 3.2 at 24 weeks in the D2T RA group.
Clinical efficacy of JAKi in D2T RA group did not differ from that in 2nd and non-D2T RA groups. Glucocorticoid use and multiple bDMARD/JAKi failure were poor prognostic factors for D2T RA.
本研究评估了Janus激酶抑制剂（JAKi）在治疗困难的类风湿关节炎（D2T RA）患者中的有效性。
本研究纳入了220例接受JAKi治疗的类风湿关节炎患者。62例患者未使用过生物改善病情抗风湿药物（bDMARDs）/JAKi（第1组），57例患者对一种bDMARDs/JAKi治疗失败（第2组），101例患者对≥2种bDMARDs/JAKi治疗失败。在这101例患者中，25例不符合D2T RA标准（非D2T RA组），76例符合D2T RA标准（D2T RA组）。
所有组在24周时DAS28-ESR均得到改善（第1组：P <.01，第2组：P <.01，非D2T RA组：P =.01，D2TRA组：P =.02），D2T RA组与第2组（P =.73）或非D2T RA组（P =.68）之间DAS28-ESR的改善率无差异。在D2T RA组中，使用糖皮质激素[比值比：8.67；95%置信区间（CI）：1.23 - 60.90；P =.03]和既往使用bDMARD/JAKi的次数≥3次（比值比：10.55；95%CI：1.39 - 80.30；P =.02）是24周时DAS28-ESR≥3.2的危险因素。
JAKi在D2T RA组中的临床疗效与第2组和非D2T RA组无差异。使用糖皮质激素和多种bDMARD/JAKi治疗失败是D2T RA预后不良的因素。
