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Effectiveness of TNF-inhibitors, abatacept, IL6-inhibitors and JAK-inhibitors in 31 846 patients with rheumatoid arthritis in 19 registers from the 'JAK-pot' collaboration
K. Lauper, M. Iudici, D. Mongin, SA. Bergstra, D. Choquette, C. Codreanu, R. Cordtz, D. De Cock, L. Dreyer, O. Elkayam, EM. Hauge, D. Huschek, KL. Hyrich, F. Iannone, N. Inanc, L. Kearsley-Fleet, EK. Kristianslund, TK. Kvien, BF. Leeb, G. Lukina,...
Jazyk angličtina Země Anglie, Velká Británie
Typ dokumentu časopisecké články, pozorovací studie
NLK
ProQuest Central
od 1939-01-01 do 2024-12-31
Health & Medicine (ProQuest)
od 1939-01-01 do 2024-12-31
Family Health Database (ProQuest)
od 1939-01-01 do 2024-12-31
ROAD: Directory of Open Access Scholarly Resources
- MeSH
- abatacept terapeutické užití MeSH
- antirevmatika * terapeutické užití MeSH
- inhibitory Janus kinas * terapeutické užití MeSH
- inhibitory TNF MeSH
- interleukin-6 MeSH
- lidé MeSH
- revmatoidní artritida * chemicky indukované farmakoterapie MeSH
- TNF-alfa MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
BACKGROUND: JAK-inhibitors (JAKi), recently approved in rheumatoid arthritis (RA), have changed the landscape of treatment choices. We aimed to compare the effectiveness of four current second-line therapies of RA with different modes of action, since JAKi approval, in an international collaboration of 19 registers. METHODS: In this observational cohort study, patients initiating tumour necrosis factor inhibitors (TNFi), interleukin-6 inhibitors (IL-6i), abatacept (ABA) or JAKi were included. We compared the effectiveness of these treatments in terms of drug discontinuation and Clinical Disease Activity Index (CDAI) response rates at 1 year. Analyses were adjusted for patient, disease and treatment characteristics, including lines of therapy and accounted for competing risk. RESULTS: We included 31 846 treatment courses: 17 522 TNFi, 2775 ABA, 3863 IL-6i and 7686 JAKi. Adjusted analyses of overall discontinuation were similar across all treatments. The main single reason of stopping treatment was ineffectiveness. Compared with TNFi, JAKi were less often discontinued for ineffectiveness (adjusted HR (aHR) 0.75, 95% CI 0.67 to 0.83), as was IL-6i (aHR 0.76, 95% CI 0.67 to 0.85) and more often for adverse events (aHR 1.16, 95% CI 1.03 to 1.33). Adjusted CDAI response rates at 1 year were similar between TNFi, JAKi and IL-6i and slightly lower for ABA. CONCLUSION: The adjusted overall drug discontinuation and 1 year response rates of JAKi and IL-6i were similar to those observed with TNFi. Compared with TNFi, JAKi were more often discontinued for adverse events and less for ineffectiveness, as were IL-6i.
Charité University Medicine Berlin Germany
Department of Development and Regeneration KU Leuven Leuven Belgium
Department of Rheumatology biorx si University Medical Centre Ljubljana Slovenia
Division of Rheumatology and Research Diakonhjemmet Hospital Oslo Norway
Division of Rheumatology KU Leuven University Hospitals Leuven Belgium
Division of Rheumatology School of Medicine Marmara University Istanbul Turkey
Epidemiology Unit German Rheumatism Research Center Berlin Germany
Faculty of Medicine University of Ljubljana Ljubljana Slovenia
GISEA DETO Rheumatology Unit University of Bari Bari Italy
Institut de recherche en rhumatologie de Montréal Montreal Quebec Canada
Private Office Hollabrunn Austria
Rheumatology Department Charles University Prag Czech Republic
Rheumatology Department Hospital Garcia de Orta on behalf of Reuma pt Almada Portugal
Rheumatology Leiden University Medical Center Leiden The Netherlands
Rheumatology Service Hospital Clinico Universitario Santiago de Compostela Spain
Rheumatology University of Medicine and Pharmacy Center of Rheumatic Diseases Bucharest Romania
Citace poskytuje Crossref.org
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- $a BACKGROUND: JAK-inhibitors (JAKi), recently approved in rheumatoid arthritis (RA), have changed the landscape of treatment choices. We aimed to compare the effectiveness of four current second-line therapies of RA with different modes of action, since JAKi approval, in an international collaboration of 19 registers. METHODS: In this observational cohort study, patients initiating tumour necrosis factor inhibitors (TNFi), interleukin-6 inhibitors (IL-6i), abatacept (ABA) or JAKi were included. We compared the effectiveness of these treatments in terms of drug discontinuation and Clinical Disease Activity Index (CDAI) response rates at 1 year. Analyses were adjusted for patient, disease and treatment characteristics, including lines of therapy and accounted for competing risk. RESULTS: We included 31 846 treatment courses: 17 522 TNFi, 2775 ABA, 3863 IL-6i and 7686 JAKi. Adjusted analyses of overall discontinuation were similar across all treatments. The main single reason of stopping treatment was ineffectiveness. Compared with TNFi, JAKi were less often discontinued for ineffectiveness (adjusted HR (aHR) 0.75, 95% CI 0.67 to 0.83), as was IL-6i (aHR 0.76, 95% CI 0.67 to 0.85) and more often for adverse events (aHR 1.16, 95% CI 1.03 to 1.33). Adjusted CDAI response rates at 1 year were similar between TNFi, JAKi and IL-6i and slightly lower for ABA. CONCLUSION: The adjusted overall drug discontinuation and 1 year response rates of JAKi and IL-6i were similar to those observed with TNFi. Compared with TNFi, JAKi were more often discontinued for adverse events and less for ineffectiveness, as were IL-6i.
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