What question did this study set out to answer?

June 6, 2026Open Access

Real-world efficacy and safety profile of four JAK inhibitors in rheumatoid arthritis: a French single-center observational study

SASalomé AbdellaouiUniversité Paris Cité OTOmar Al TabaaBP (France)SHStéphane HilliquinUniversité Paris Cité

Puntos clave

Evaluate the real-world effectiveness and safety of Janus kinase inhibitors (JAKi) in rheumatoid arthritis treatment maintenance.
Retrospective single-center study of RA patients initiating first JAKi between April 2018 and November 2023.
Primary endpoint assessed was treatment maintenance using Kaplan-Meier analysis.
Secondary outcomes included DAS28-CRP changes at 6 and 12 months and reasons for treatment discontinuation.
Overall treatment maintenance was 73% at 12 months, decreasing to 57% at 36 months.
Baricitinib had the highest long-term persistence, while filgotinib showed excellent 12-month survival in low-risk patients.
Serious adverse events were linked to high-risk patients before PRAC recommendations, with no major events reported post-PRAC.

Resumen

OBJECTIVE: To evaluate real-world treatment maintenance, effectiveness, and safety of Janus kinase inhibitors (JAKi) in rheumatoid arthritis (RA), and to assess changes in prescribing patterns following the October 2022 PRAC recommendations. METHODS: This retrospective single-center study included all consecutive RA patients initiating a first JAKi (tofacitinib, baricitinib, upadacitinib, or filgotinib) between April 2018 and November 2023. The primary endpoint was treatment maintenance (Kaplan-Meier). Secondary outcomes included changes in DAS28-CRP and DAS28 at 6 and 12 months and reasons for treatment discontinuation. Patients initiating JAKi before versus after PRAC were compared. RESULTS: Among 120 patients (85% women, mean age 57 ± 14 years, mean disease duration 19 ± 12 years, mean follow-up of 21 ± 16 months), overall treatment maintenance was 73% at 12 months, 62% at 24 months, and 57% at 36 months. Baricitinib showed the highest long-term persistence, whereas filgotinib demonstrated excellent 12-month survival in younger, low-risk patients. All JAKi significantly improved disease activity, with reductions in DAS28-CRP of -1.57 ± 1.26 at 6 months and -1.13 ± 1.63 at 12 months. Forty-nine discontinuations occurred (57% inefficacy, 35% intolerance) after a mean follow-up of 15 ± 15 months. Serious adverse events included three pulmonary embolisms and one myocardial infarction, all in high-risk patients before PRAC. No major cardiovascular events, venous thromboembolism, or malignancies occurred after PRAC recommendations. CONCLUSION: JAKi demonstrated effectiveness and acceptable long-term persistence. Safety outcomes were strongly influenced by baseline cardiovascular risk, underscoring the need for careful patient selection following PRAC guidance. Key Points • In routine care, all four JAK inhibitors demonstrated clinically meaningful effectiveness despite long-standing, severe and comorbid rheumatoid arthritis. • Treatment persistence differed across JAK inhibitors, but observed differences were largely driven by patient profiles and prescribing context rather than clear drug-related effects. • Implementation of PRAC recommendations in October 2022 markedly modified patient selection, with exclusion of high cardiovascular and thromboembolic risk profiles. • Serious cardiovascular and thromboembolic events occurred exclusively in high-risk patients treated before PRAC recommendations.

Preguntar a la IA

Me gusta

Guardar

Ver artículo completo