Study Finds Greater Pain Reduction With JAKis Over bDMARDs in Third-Line RA
In other populations, JAKis demonstrated at least a similar pain benefit to b/tsDMARDs from baseline.
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New research has found that Janus kinase inhibitors (JAKis) had a slightly better effect on pain in patients with rheumatoid arthritis (RA), compared with tumor necrosis factor inhibitors (TNFis), with patients who had previously been treated with at least 2 biologic disease-modifying anti-rheumatic drugs (bDMARDs) experiencing the greatest differences. JAKis also had similar pain reduction effects to other, non TNFi-bDMARDs.1
“So far, only limited results are available from observational studies comparing the effectiveness of JAKis and bDMARDs on pain reduction in clinical practice, especially when it comes to non-TNFi bDMARDs,” lead investigator Anna Eberhard, MD, PhD candidate, Rheumatology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden, and colleagues wrote.1
Eberhard and colleagues analyzed data from patients with RA starting treatment with a JAKi (n = 1827), TNFi (n = 6422), IL-6 inhibitor (n = 887), abatacept (n=1102) or rituximab (n = 1149) in 2017-2019, from several linked Swedish national registers, in a retrospective study. They assessed differences between treatments in change in pain with a visual analogue scale (VAS; 0-100 mm), from baseline to 3 months, and the proportions of patients remaining on initial treatment with low pain (VAS pain <20) at 12 months. They used multivariable linear regression, adjusted for patient characteristics, comorbidities, current co-medication and previous treatment, to compare treatment responses between JAKis and bDMARDs.1
“In particular, it has been reported that JAKis may have a special impact on pain.2 Specifically, in the RA-BEAM and SELECT-COMPARE trials, treatment with baricitinib and upadacitinib, respectively, resulted in greater pain reduction compared with adalimumab,” Eberhard and colleagues wrote.1
The investigators found that JAKi treatment was associated with a greater decrease in pain at 3 months compared with TNFi treatment (adjusted mean additional decrease, 4.0 mm [95% CI,1.6-6.3]), with similar findings in comparison to other non-TNFi bDMARDs. More patients achieved low pain at 12 months on JAKis compared with TNFis, especially among those previously treated with at least 2 bDMARDs (adjusted change contrast, 5.3% [95% CI 1.0-9.6]). They found no significant differences between pain responses in patients starting bDMARD/targeted synthetic monotherapy or combination therapy with conventional synthetic DMARDs.1
Of patients treated with JAKis, 20% remained on drug and reached low pain at 12 months from baseline, while this proportion ranged from 17% (IL-6) to 26% (rituximab) for patients on bDMARDs. After adjustment, there were numerically higher proportions of patients remaining on JAKis with low pain than on TNFis or IL-6is, but these differences were not statistically significant. Among those with low pain at 12 months, less patients were in than among those treated with TNFis.1
“Although differences were modest, JAKis had a slightly better effect on pain outcomes at 3 and 12 months in this study compared with TNFis, particularly in patients previously treated with at least 2 bDMARDs and when given as monotherapy. In addition, JAKis were at least as effective in reducing pain as non-TNFi bDMARDs,” Eberhard and colleagues concluded.1
REFERENCES
Eberhard A, Giuseppe DD, Askling J, et al. Effectiveness of janus kinase inhibitors compared with biologic disease modifying anti-rheumatic drugs on pain reduction in rheumatoid arthritis. Arthritis Rheumatol. Published online September 22, 2024. doi.org/10.1002/art.43014
Harrington R, Al Nokhatha SA, Conway R. JAK Inhibitors in Rheumatoid Arthritis: An Evidence-Based Review on the Emerging Clinical Data. J Inflamm Res 2020;13:519-531. DOI:10.2147/JIR.S219586
