POS0856 MONOTHERAPY AND FIRST LINE USE ARE ASSOCIATED WITH HIGHER JAK-INHIBITOR RETENTION RATES IN PATIENTS IN BOTH RHEUMATOID AND PSORIATIC ARTHRITIS: A RETROSPECTIVE REAL-WORLD STUDY

• Published in: Annals of the rheumatic diseases Vol. 82; no. Suppl 1; p. 732
• Main Authors: Luciano, N, Barone, E, Brunetta, E, De Santis, M, Ceribelli, A, Caprioli, M, Guidelli, G M, Sonaglia, A, Renna, D, Isailovic, N, Selmi, C
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2023
• Subjects: Cardiovascular diseases; Comorbidity; Confidence intervals; Diabetes mellitus; Gender; Herpes zoster; Hypertension; Ischemia; Janus kinase; Multivariate analysis; Myocardial infarction; Obesity; Patients; Psoriatic arthritis; Respiratory tract; Rhabdomyolysis; Rheumatoid arthritis; Rheumatoid factor; Risk factors; Safety; Smoking; Thromboembolism; Thrombosis
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2023-eular.4140

BackgroundJanus kinase inhibitors (JAKi) have been licensed for the treatment of rheumatoid (RA) and psoriatic arthritis (PsA) and currently there is limited evidence of differences among the four available molecules while real-world data are needed for safety and efficacy.ObjectivesTo investigate the efficacy and safety of approved JAKi and analyze the relationship between the patients’ baseline characteristics and drug survival.MethodsThis is a retrospective study on patients treated in 2021-2022 with tofacitinib, baricitinib, upadacitinib, or filgotinib for RA or with tofacitinib, baricitinib or upadacitinib for PsA as first or subsequent line of therapy after the failure of one or more conventional DMARD. We collected demographic and clinical data including clinimetric indices and registered the presence of comorbidities, smoking, and previous DMARDs.ResultsThe study included 205 patients (81% women) who started or continued a JAKi for RA or PsA between January 2021 and October 2022 (Table 1) and were followed until the cutoff on October 31, 2022 for a median of 24 (interquartile range 12-40) months for a total observation of 431 patients-years. One hundred-two (50%) patients received the JAKi as first-line treatment and 108 (53%) as monotherapy. At the last available observation, 144 (72%) patients were still on JAKi, with 27% of patients (54/205) reporting a temporary discontinuation of the therapy, in 69% of cases due to bacterial or viral infections of the upper respiratory tract. Forty-one (20%) patients stopped the JAKi for inefficacy, in 18 (44%) being a primary failure. Eighteen serious adverse events were observed; e.g. 12 major infections, mainly pneumonia, 2 venous thrombotic events, 3 ischemic cardiovascular events and one rhabdomyolysis. Among the 5 patients reporting thrombosis or myocardial infarction, 4 were older than 65 and all had at least one cardiovascular risk factor, mostly obesity and arterial hypertension. Non-disseminated Herpes zoster reactivation was registered in 19 patients but none required the discontinuation of the JAKi. Better retention rates were registered at univariate analysis in bio-naïve patients (p=0.002) and in patients on JAKi monotherapy (p=0.026), while no significant correlation was found with disease duration, comorbidities, and smoking habits. The multivariate analysis confirmed that receiving JAKi as monotherapy (p=0.04, odds ratio 2.01, 95% confidence interval 1.03-3.94) is associated with a longer treatment duration, opposite to having failed one bDMARD before receiving a JAKi (p=0.001, odds ratio 0.29, 95% confidence interval 0.14-0.6), irrespective of gender, age, and disease duration. Having RA or PsA did not impact the treatment duration.ConclusionIrrespective of the diagnosis of RA or PsA, JAKi cumulatively have the best treatment duration when are used as monotherapy or as first line before a bDMARD. The safety and efficacy profiles did not differ significantly between RA and PsA, albeit a limited number of patients were included in the latter group.Table 1.Total (n=205)RA (n=187)PsA (n=18)Age (years) (median; IQR)62 (53-71)61.9 (54-72)56.6 (48.7-62.0)Female gender [n (%)]166 (81%)152 (81%)14 (77%)Rheumatoid Factor positive [n (%)]117 (57%)117 (63%)0 (0%)ACPA positive [n (%)]121 (59%)121 (65%)0 (0%)TherapiesDuration of JAKi therapy (median; IQR)24 (12-40)28 (13-41)8.6 (4-14.5)bDMARDs naive [n (%)]102 (50%)97 (52%)11 (61%)JAKi monotherapy [n (%)]108 (53%)99 (53%)3 (17%)Baricitinib [n (%)]123 (60%)122 (65%)1 (6%)Upadacitinib [n (%)]46 (22%)16 (9%)2 (11%)Tofacitinib [n (%)]18 (9%)31 (17%)15 (83%)Filgotinib [n (%)]18 (9%)18 (10%)0 (0%)ComorbiditiesPrevious or current smoker [n (%)]61 (30%)58 (31%)3 (17%)Obesity [n (%)]45 (22%)37 (20%)8 (44%)Hypertension [n (%)]69 (34%)65 (35%)4 (22%)Diabetes [n (%)]13 (6%)13 (7%)0 (0%)Previous Venous Thromboembolism [n (%)]5 (2%)4 (2%)1 (6%)Coronary Arthery Disease [n (%)]19 (9%)18 (10%)1 (6%)REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNicoletta Luciano Speakers bureau: Abbvie, BMS, Ely-Lilly, Janssen, Consultant of: Galapagos, Elisa Barone: None declared, Enrico Brunetta: None declared, Maria De Santis: None declared, Angela Ceribelli: None declared, Marta Caprioli: None declared, Giacomo Maria Guidelli Speakers bureau: Janssen, Eli-Lilly, Novartis, Abbvie, Galapagos, Consultant of: Janssen, Arianna Sonaglia: None declared, Daniela Renna Speakers bureau: Janssen, Natasa Isailovic: None declared, Carlo Selmi Speakers bureau: Abbvie, Amgen, Alfa-Wassermann, Biogen, Eli-Lilly, Galapagos, Novartis, Janssen, Pfizer, SOBI, Consultant of: Abbvie, Amgen, Alfa-Wassermann, Biogen, Eli-Lilly, Galapagos, Novartis, Janssen, Pfizer, SOBI, Grant/research support from: Abbvie, Amgen, Pfizer.