Patient Factors Influence Targeted Therapy Selection for Rheumatoid Arthritis

Yoon Kyoung Sung

New research from Korea identified factors influencing the selection of Janus kinase (JAK) inhibitors over biologic disease-modifying antirheumatic drugs (bDMARDs) for patients with rheumatoid arthritis (RA).

Factors such as age, the absence of pulmonary comorbidities, previous tacrolimus use, and high disease activity influenced the selection of JAK inhibitors, while the presence of chronic pulmonary diseases and higher functional disability favored bDMARDs.

“About one-third of the patients in our study received JAK inhibitors, indicating that JAK inhibitor use kept up with tumor necrosis factor (TNF) inhibitor and non-TNF inhibitor use,” wrote corresponding author Yoon Kyoung Sung, Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases.

The agents used for targeted therapy have different methods of action, but there are no clinically important differences in efficacy. As a result, JAK inhibitors, TNF inhibitors, and non-TNF inhibitors are recommended for RA patients who show inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

New guidance highlighted the use of sequential treatment according to a treat-to-target strategy when using target therapy, leading to a significant change in the greater paradigm of RA treatment. The current study looked to identify factors influencing the selection of JAK inhibitors as a first-targeted therapy in patients with RA, who were refractory to csDMARDs in real-world practice.

Two prospective cohorts at an academic referral hospital in Korea were used for the baseline data. All patients with RA who started targeted therapy in our institution were admissible to the cohorts, but those who refused to give informed consent were excluded. Those who started targeted therapy between March 2017 and August 2020 were divided into three groups in accordance with the targeted therapy they received: JAK inhibitor, TNF inhibitor, and non-TNF inhibitor groups.

Enrolled patients received physician examination and interviews on the day of registration to collect enrollment and follow-up data, including demographic features and clinical information, such as laboratory results. Data related to RA was additionally investigated including disease duration, disease activity, and patient-reported outcomes. In multinomial regression analyses, investigators analyzed factors that induced physicians and patients to choose JAK inhibitors instead of TNF inhibitors or non-TNF inhibitors.

A total of 633 patients who started JAK inhibitors or bDMARDs from March 2017 to August 2020 were identified by investigators. After exclusions, a total of 439 patients who had been naive to targeted therapy were included in the study. Of this number, 145 patients started JAK inhibitors, 205 started TNF inhibitors, and 89 patients started non-TNF inhibitors.

In multinomial logistic regression analysis, the findings indicate the JAK inhibitor group was less likely to have chronic pulmonary disease compared with the TNF inhibitor group (OR, 0.07; 95% CI, 0.01 – 0.56) or the non-TNF inhibitor group (OR, 0.06; 95% CI, 0.01 – 0.50).

It noted the Physician’s Global Assessment (PGA) of disease activity was higher in the JAK inhibitor group than the TNF inhibitor group, while JAK inhibitor users showed lower Health Assessment Questionnaire-Disability Index (HAQ-DI) scores. The analysis additionally revealed the JAK inhibitor group was older than the TNF inhibitor group, but younger than the non-TNF inhibitor group.

Duration of disease of RA was longer in JAK inhibitor users than non-TNF inhibitor users (OR, 1.05; 95% CI, 1.00 - 1.09), but the difference was marginal in TNF inhibitor users. Previous tacrolimus use was additionally cited as a factor suggesting the selection of JAK inhibitors over TNF inhibitors (OR, 2.05; 95% CI, 1.20 – 3.51).

“To elucidate the factors underlying selection of type of targeted therapy, further studies with large sample sizes that include socioeconomic status of patients and assess the effectiveness of shared decision-making processes would be informative,” Sung added.

The study, “Factors associated with selection of targeted therapy in patients with rheumatoid arthritis,” was published in PLOS One.