Clinician and patient views on janus kinase inhibitors in the treatment of inflammatory arthritis: a mixed methods study

Abstract

Background: Janus kinase inhibitors (JAKi) are new targeted synthetic disease-modifying antirheumatic drugs (DMARDs) licenced in the UK to treat rheumatoid and psoriatic arthritides. Unlike currently often prescribed biological DMARDs, they target a different part of the inflammatory pathway and are taken orally. The aim of this study was to explore what UK-based rheumatology clinicians and inflammatory arthritis (IA) patients think about the awareness, prescription and use of JAKi; how they compare with biologics; and how the COVID-19 pandemic has affected how JAKi are viewed and prescribed.

Methods: Rheumatology clinicians and IA patients completed online surveys and participated in interviews/focus groups between September 2021 and January 2022. Survey data were analysed descriptively, and interview/focus group data underwent an inductive thematic analysis.

Results: 66.6% of patients had at least some awareness of JAKi, 73.0% from their rheumatology team. Problems getting earlier access to these drugs were raised by some patients, with many being prescribed JAKi after multiple other therapies had failed. 91.5% of clinicians prescribed JAKi in keeping with their local guidelines, with 72.3% prescribing them frequently as a monotherapy. Some clinicians had lingering safety concerns over JAKi use. Despite experiencing side effects and knowing of possible long-term risks, patients felt overall the benefits of JAKi outweighed the risks. 39.3% of patients were 'very satisfied' on JAKi, compared with 25.0% on biologics. Patients on JAKi appreciated their short half-life when it comes to infections, and their convenience as an oral therapy. When JAKi were discontinued in patients, it was predominantly due to inefficacy and non-cardiovascular adverse events. The COVID-19 pandemic resulted in increased prescription of JAKi as an alternative to injections and infusions, primarily to avoid potentially exposing patients to the coronavirus. Some patients believed their JAKi may confer some protection against developing severe COVID-19.

Conclusion: JAKi are an effective treatment option for IA and are liked by patients. The COVID-19 pandemic appears to have impacted their prescription favourably. However, clinicians have safety concerns over JAKi use. Any decision to go on a JAKi should be informed and take into account individual patient risk factors, circumstances and preferences.

Keywords: COVID-19; Clinical practice; Focus groups; Inflammatory arthritis; JAK inhibitors; Mixed methods; Patient perspective; Psoriatic arthritis; Rheumatoid arthritis; Surveys.

Fig. 1

Point at which JAKi therapy usually started (multiple response). b = biological; c = conventional; DMARD = disease-modifying antirheumatic drug

Fig. 2

Reasons for feeling less confident in prescribing a JAKi compared with other advanced therapies (multiple response). N/A = not applicable

Fig. 3

Discontinued JAKi in patients? (multiple response). AEs = adverse events; HZ = herpes zoster; MACE = major adverse cardiovascular event; TEE = thromboembolic event

Fig. 4

COVID-19 pandemic affected your JAKi prescription?

Fig. 5

Overall satisfaction with arthritis medication

Fig. 6

Sources from which patients heard about JAKi (multiple response)