Efficacy and safety of switching Jak inhibitors in rheumatoid arthritis: an observational study

Retuerto, Miriam; Trujillo, E.; Valero, Cristina; Fernández-Espartero, Cruz; Soleto, C. Y.; García-Valle, A.; Aurrecoechea, Elena; Garijo, M.; López, A.; Loricera, J.; Pablos, José L.

doi:10.55563/clinexprheumatol/cbanza

Cited by 14 publications

(8 citation statements)

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“…To reduce the impact of missing data, baseline characteristics were imputed as the values available in a short time frame, which may increase measurement error. Nonetheless, our results are broadly in agreement with previous reports 17 19 20…”

Section: Discussionsupporting

confidence: 94%

“…Reports with small sample size support that the use of a second JAKi is a safe and effective option after discontinuation of the first JAKi 19 20. On the other hand, one study showed clinically meaningful response to bDMARD after failure with JAKi 17.…”

Section: Discussionmentioning

confidence: 99%

“…Although there is no evidence that differences in affinity influence response to JAKi, based on previous experience with cycling of TNFi, a second JAKi is often used in case of failure to the first JAKi. There are only limited clinical data to support this strategy; two small observational studies reported that the use of a second JAKi was a safe and effective option after discontinuation of the first JAKi 19 20…”

Section: Introductionmentioning

confidence: 99%

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After JAK inhibitor failure: to cycle or to switch, that is the question – data from the JAK-pot collaboration of registries

et al. 2022

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ObjectivesThe expanded therapeutic arsenal in rheumatoid arthritis (RA) raises new clinical questions. The objective of this study is to compare the effectiveness of cycling Janus kinase inhibitors (JAKi) with switching to biologic disease-modifying antirheumatic drug (bDMARD) in patients with RA after failure to the first JAKi.MethodsThis is a nested cohort study within data pooled from an international collaboration of 17 national registries (JAK-pot collaboration). Data from patients with RA with JAKi treatment failure and who were subsequently treated with either a second JAKi or with a bDMARD were prospectively collected. Differences in drug retention rates after second treatment initiation were assessed by log-rank test and Cox regression analysis adjusting for potential confounders. Change in Clinical Disease Activity Index (CDAI) over time was estimated using a linear regression model, adjusting for confounders.Results365 cycling and 1635 switching patients were studied. Cyclers were older and received a higher number of previous bDMARDs. Both strategies showed similar observed retention rates after 2 years of follow-up. However, adjusted analysis revealed that cycling was associated with higher retention (p=0.04). Among cyclers, when the first JAKi was discontinued due to an adverse event (AE), it was more likely that the second JAKi would also be stopped due to an AE. Improvement in CDAI over time was similar in both strategies.ConclusionsAfter failing the first JAKi, cycling JAKi and switching to a bDMARD appear to have similar effectiveness. Caution is advised if an AE was the reason to stop the first JAKi.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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After JAK inhibitor failure: to cycle or to switch, that is the question – data from the JAK-pot collaboration of registries

et al. 2022

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“…Data on switching between oral Jak inhibitors in the treatment of AA are limited. However, in rheumatoid arthritis, efficacy has been shown in patients who switch to a different Jak inhibitor after an inadequate response to a previous Jak inhibitor ( Ebina et al., 2022 ; Retuerto et al., 2021 ). This analysis was limited by the small number of patients, single-dosage regimen of each study drug, and open-label study design.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Ritlecitinib and Brepocitinib in Alopecia Areata: Results from the Crossover Open-Label Extension of the ALLEGRO Phase 2a Trial

King¹,

Guttman‐Yassky²,

Peeva³

et al. 2022

JID Innovations

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“…With the availability of biosimilar bDMARDs with markedly reduced cost in many regions of the world, trying a more cost effective medication, even with the same MOA, may be preferable in many instances than switching to a more costly alternative, even if the MOA is different. Similarly, JAKi cycling can be effective 10 11. Data from the Swiss registry already suggested that after JAK inhibitor treatment, drug retention was superior when switching to another JAKi than to a TNFi 12.…”

mentioning

confidence: 99%

Jack pot! What can we learn about registries with respect to treatment cycling in rheumatoid arthritis?

Pope

Fleischmann

2023

Ann Rheum Dis

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Efficacy and safety of switching Jak inhibitors in rheumatoid arthritis: an observational study

Cited by 14 publications

References 0 publications

After JAK inhibitor failure: to cycle or to switch, that is the question – data from the JAK-pot collaboration of registries

After JAK inhibitor failure: to cycle or to switch, that is the question – data from the JAK-pot collaboration of registries

Safety and Efficacy of Ritlecitinib and Brepocitinib in Alopecia Areata: Results from the Crossover Open-Label Extension of the ALLEGRO Phase 2a Trial

Jack pot! What can we learn about registries with respect to treatment cycling in rheumatoid arthritis?

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