Factors associated with discontinuation of bDMARDs and JAK inhibitors in patients with rheumatoid arthritis: a retrospective study.

OBJECTIVES

To compare the discontinuation rates of different biologic agents and Janus kinase (JAK) inhibitors in patients with rheumatoid arthritis (RA) and identify the reasons and associated factors for discontinuation.

METHOD: In this retrospective observational study, data were retrospectively collected from patients with RA who were treated with biological agents and JAK inhibitors at the Rheumatology and Immunology Department of Taizhou Hospital of Zhejiang Province between January 2021 and March 2024. Reasons for discontinuation were categorized, and factors associated with drug discontinuation and retention were assessed.

RESULTS

Analysis of 242 treatment records (from 218 patients) revealed an overall treatment discontinuation rate of 43.4%. The median follow-up was 21.4 months (interquartile range [IQR], 12.0-35.5). JAK inhibitors, specifically tofacitinib, were associated with significantly superior drug retention compared to TNF inhibitors and tocilizumab. Although elevated pretreatment inflammatory markers-white blood cell (WBC) counts and C-reactive protein (CRP) were associated with discontinuation in univariate analysis, this association was not significant after adjusting for other variables. Multivariable logistic regression identified lack of medical insurance as an independent risk factor for discontinuation, while JAK inhibitor usage was an independent protective factor. The finding of superior retention for JAK inhibitors was confirmed in a propensity score-matched analysis.

CONCLUSIONS

In conclusion, our findings highlight lack of insurance, male sex and drug class as key factors associated with treatment discontinuation in routine care, with tofacitinib showing promising retention. These real-world predictors merit consideration in patient management while acknowledging that observational data supports hypothesis generation for future interventional studies. Key Points • JAK inhibitor use (particularly tofacitinib) was an independent protective factor, associated with superior drug retention compared to other classes. • Socioeconomic factors (insurance and cost) outweighed baseline inflammatory markers as predictors of treatment persistence in the real-world setting.