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Real-world comparative study of drug retention of Janus kinase inhibitors in patients with rheumatoid arthritis.
- Source :
-
PloS one [PLoS One] 2024 Jul 11; Vol. 19 (7), pp. e0306714. Date of Electronic Publication: 2024 Jul 11 (Print Publication: 2024). - Publication Year :
- 2024
-
Abstract
- Background: Janus kinase (JAK) inhibitors (JAKis) are effective therapeutic agents against rheumatoid arthritis (RA). However, patients having RA with particular risk factors may have a higher incidence of adverse effects (AEs), including major cardiovascular events (MACE) and infections. In this multicenter cohort study, we aimed to clarify the risk factors affecting the drug retention of JAKis in patients with RA.<br />Methods: We retrospectively evaluated patients with RA who received their first JAKi (tofacitinib, baricitinib, upadacitinib, or filgotinib) at our institute. The clinical outcomes, including AEs, were recorded, particularly MACE and serious infections. The drug retention rates were analyzed using the Kaplan-Meier method, and risk factors affecting drug retention rates were determined using a multivariable Cox regression hazards model.<br />Results: Overall 184 patients with RA receiving their first use of baricitinib (57.6%), tofacitinib (23.9%), upadacitinib (12.0%), or filgotinib (6.5%) were included in this study. Fifty-six (30.4%) patients discontinued JAKi treatment owing to ineffectiveness (9.2%) or AEs, including infections (21.2%). The overall drug retention rates were significantly lower in patients treated with pan-JAKi than in those treated with JAK1 inhibitors (p = 0.03). In the Cox regression model, the presence of baseline high RA disease activity, use of glucocorticoid and treatments with pan-JAKis were associated with reduced drug retention rates of JAKis (p < 0.001, p = 0.01 and 0.04, respectively). Pan-JAKi treated patients with high disease activity had significantly lower drug retention rates (p < 0.001).<br />Conclusions: In a real-world setting, the drug retention rates of JAKis were reduced mainly by treatment discontinuation owing to AEs. Treatment with pan-JAKis and high baseline RA disease activity were identified as predictive factors for the discontinuation of JAKis. Lower drug retention rates were found in patients receiving pan-JAKis with high disease activity than in those without high disease activity.<br />Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: K.M. has received research grants from Chugai Pharmaceutical Co., Ltd. and Novartis Pharma K.K. The above-mentioned pharmaceutical companies were not involved in the study design, data collection and analysis, manuscript writing, and manuscript submission. Rest of the authors declare that they have no conflict of interests.<br /> (Copyright: © 2024 Saito et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
- Subjects :
- Humans
Male
Female
Middle Aged
Retrospective Studies
Aged
Pyrimidines therapeutic use
Pyrimidines adverse effects
Heterocyclic Compounds, 3-Ring therapeutic use
Heterocyclic Compounds, 3-Ring adverse effects
Antirheumatic Agents therapeutic use
Antirheumatic Agents adverse effects
Triazoles therapeutic use
Triazoles adverse effects
Risk Factors
Adult
Pyridines
Arthritis, Rheumatoid drug therapy
Janus Kinase Inhibitors therapeutic use
Janus Kinase Inhibitors adverse effects
Azetidines therapeutic use
Azetidines adverse effects
Pyrazoles therapeutic use
Pyrazoles adverse effects
Purines therapeutic use
Purines adverse effects
Sulfonamides therapeutic use
Sulfonamides adverse effects
Piperidines therapeutic use
Piperidines adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 19
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 38990897
- Full Text :
- https://doi.org/10.1371/journal.pone.0306714