Joint bone spine · 2026
JAK Inhibitor Cycling Shows Higher Drug Retention than Biologic Switching Following First JAK Inhibitor Failure in Rheumatoid Arthritis.
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Tsai Ming-Hsuan, Sheu Heh-Shiang, Wang Kai-Chun, Kuo Ping-Hsuan, Chen Yi-Ming, Huang Wen-Nan, Shih Meng-Chieh, Ling-Ying Lu, Chen Wei-Sheng, Liao Hsien-Tzung, Lai Chien-Chih, Tsao Yen-Po, Sun Yi-Syuan, Tsai Hung-Cheng, Hsieh Tsu-Yi, Chen Hsin-Hua, Lai Kuo-Lung, Lin Ching-Tsai, Hsieh Chia-Wei, Tseng Jui-Cheng, Jui-Chieh Hu, Wang Li-Fong, Yen Ling-Jung, Chen Ming-Han
Аннотация
OBJECTIVES: Evidence guiding treatment sequencing after JAK inhibitor failure in rheumatoid arthritis remains limited. This study compared treatment persistence and clinical effectiveness between JAK inhibitor cycling and biologic switching after discontinuation of an initial JAK inhibitor due to inadequate response.
METHODS: This multicenter retrospective cohort study included only patients who discontinued their first JAK inhibitor due to inadequate response. The primary outcome was 12-month drug retention. Inverse probability of treatment weighting was used to balance baseline characteristics. Secondary outcomes included reasons for discontinuation within 12 months and clinical effectiveness at 6 months, assessed using the response criteria of the European Alliance of Associations for Rheumatology.
RESULTS: Among the 186 patients, 44 (23.7%) cycled to another JAK inhibitor and 142 (76.3%) switched to biologic therapy. After adjustment using inverse probability of treatment weighting, cycling was associated with significantly higher 12-month drug retention than switching (hazard ratio, 0.27; 95% CI, 0.10-0.71; P < 0.01). This difference was mainly driven by fewer discontinuations owing to insufficient efficacy. Concomitant glucocorticoid use independently predicted improved retention (adjusted hazard ratio, 0.50; 95% CI, 0.28-0.92; P < 0.05). At 6 months, good or moderate response rates were not significantly different between groups (78.6% vs. 62.0%), although multivariable analysis favored cycling (odds ratio, 3.41; 95% CI, 1.03-11.29; P < 0.05).
CONCLUSIONS: Among patients with rheumatoid arthritis who had an inadequate response to their first JAK inhibitor, cycling to another JAK inhibitor was associated with superior 12-month drug retention with comparable short-term clinical effectiveness.
METHODS: This multicenter retrospective cohort study included only patients who discontinued their first JAK inhibitor due to inadequate response. The primary outcome was 12-month drug retention. Inverse probability of treatment weighting was used to balance baseline characteristics. Secondary outcomes included reasons for discontinuation within 12 months and clinical effectiveness at 6 months, assessed using the response criteria of the European Alliance of Associations for Rheumatology.
RESULTS: Among the 186 patients, 44 (23.7%) cycled to another JAK inhibitor and 142 (76.3%) switched to biologic therapy. After adjustment using inverse probability of treatment weighting, cycling was associated with significantly higher 12-month drug retention than switching (hazard ratio, 0.27; 95% CI, 0.10-0.71; P < 0.01). This difference was mainly driven by fewer discontinuations owing to insufficient efficacy. Concomitant glucocorticoid use independently predicted improved retention (adjusted hazard ratio, 0.50; 95% CI, 0.28-0.92; P < 0.05). At 6 months, good or moderate response rates were not significantly different between groups (78.6% vs. 62.0%), although multivariable analysis favored cycling (odds ratio, 3.41; 95% CI, 1.03-11.29; P < 0.05).
CONCLUSIONS: Among patients with rheumatoid arthritis who had an inadequate response to their first JAK inhibitor, cycling to another JAK inhibitor was associated with superior 12-month drug retention with comparable short-term clinical effectiveness.