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Background: JAK inhibitors have an increasing role in treating different arthropathies. Yet, there are no head-to-head randomised clinical trials to investigate the superiority of one drug over another. The role of selectivity of different JAK inhibitors on efficacy and drug retention is still unknown, and their side effects profiles among the Middle Eastern ethnicities are still not reported. Objectives: The objective of this study was to assess the difference in retention rate among different JAK inhibitors with different JAK selectivity profiles and identify potential factors affecting the retention rate in the Arab population residing in the Gulf region. Methods: Registry data of patients from eight teritary centers located in Saudi Arabia, United Arab Emirates, and Qatar were used for this study. Data were collected, retrospectively, for all patients who received tofacitinib, baricitinib or upadacitinib over the past eight years. Data analysis was conducted using SPSS 29. Descriptive and inferential statistics were used, as appropriate to the type of data. Level of significance was set at 5%. Results: Data pertaining to a total of 459 patients, who received JAK inhibitors, were analyzed in this study. Of all patients, 245 (53.4%) had tofacitinib, 104 (22.7%) had baricitinib and 110 (24.0%) received upadacitinib. The mean age (sd; range) of the patients was 51.0 (13.5; 16 - 86), 53.6 (15.7; 17 - 93) and 51.9 (14.1; 24 - 93) years for tofacitinib, baricitinib, and upadacitinib, respectively. Among the study patients, 127 (52.0%) of tofacitinib, 36 (36.4%) of baricitinib and 40 (36.4%) of upadacitnib were b-DMARD naïve. The 6 month retention rate was 87.4%, 89.7%, and 73.6% for tofacitinib, baricitinib, and upadacitinib, respectively (Chi-square=13.300, df=2, p-value=0.001), while the 12 month retention rates for Tofacitinib, Baricitinib and Upadacitinib were 74.5%, 70.1% and 57.5%, respectively (Chi-square=9.946, df=2, p-value=0.007). The 3-year retention rates for tofacitinib, baricitinib and upadacitinib were 33.5%, 16.5% and 9.4%, respectively (Chi-square=27.097, df=2, p-valueConclusion: This real-world evidence registry data suggests potential difference between the retention rate of the three JAK inhibitors with different JAK selectivity indicating potential difference in their efficacy and sustainability. Head to head clinical trial will be required to confirm if there is any superiority of a medication over another. Acknowledgements: NIL. Disclosure of Interests: None declared.
Zayat et al. (Sat,) studied this question.