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Comparative Study
. 2025 Apr 1;64(4):1698-1704.
doi: 10.1093/rheumatology/keae455.

Glucocorticoid sparing effect of Janus kinase inhibitors compared to biologic disease modifying anti-rheumatic drugs in rheumatoid arthritis, a single-centre retrospective analysis

Giovanni Adami  1 , Riccardo Bixio  1 , Giulia Virelli  1 , Isotta Galvagni  1 , Francesca Mastropaolo  1 , Andrea Morciano  1 , Francesca Ruzzon  1 , Valeria Messina  1 , Elena Fracassi  1 , Davide Gatti  1 , Ombretta Viapiana  1 , Antonio Carletto  1 , Maurizio Rossini  1
Affiliations
Comparative Study

Glucocorticoid sparing effect of Janus kinase inhibitors compared to biologic disease modifying anti-rheumatic drugs in rheumatoid arthritis, a single-centre retrospective analysis

Giovanni Adami et al. Rheumatology (Oxford). .

Abstract

Background: Glucocorticoid sparing in rheumatoid arthritis (RA) treatment is crucial to minimizing adverse effects associated with long-term use. Janus kinase inhibitors (JAKi) could potentially offer a more potent glucocorticoid-sparing effect than biologic DMARDs (bDMARDs).

Material and methods: This is a single-centre retrospective analysis of RA patients treated with JAKi or bDMARDs. Glucocorticoid tapering, rescue therapy and discontinuation were analysed through mixed-effects models, Poisson regression and multivariable logistic regression, respectively, adjusting for baseline disease activity, demographic factors and treatment line.

Results: A total of 716 RA patients treated with JAKi (n = 156) or bDMARDs (n = 560) were evaluated. JAKi treatment was associated with a more rapid reduction in glucocorticoid dose within the first 6 months and 60% higher odds of discontinuation compared with bDMARDs (adjusted odds ratio 1.63; 95% CI: 1.02, 2.60, P = 0.039). Despite a higher baseline glucocorticoid dose, over 50% of JAKi-treated patients discontinued glucocorticoids after 12 months, vs ∼40% for bDMARDs. The need for glucocorticoid rescue therapy was significantly higher in the bDMARD group (rate ratio 2.66; 95% CI: 1.88, 3.74).

Conclusion: Our findings indicate that JAKi facilitate more rapid glucocorticoid tapering compared with bDMARDs in RA patients. These results underscore the potential of JAKi to reduce long-term glucocorticoid exposure, highlighting their value in RA management strategies, including minimizing glucocorticoid-related adverse effects.

Keywords: JAKi; TNFi; baricitinib; filgotinib; glucocorticoid; tofacitinib; upadacitinib.

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Figures

Figure 1.
Figure 1.
Least-squares mean change in DAS28-CRP (A) and glucocorticoid dose mg/day (B). bDMARDs: biologic DMARDs; DAS28: disease activity score for 28 joints; JAKi: Janus kinase inhibitors; LS: least squares
Figure 2.
Figure 2.
Rate ratio (RR) and 95% confidence intervals for the need of glucocorticoid rescue therapy over the follow-up period. RR indicates the factor by which the event rate increases (for RR >1) or decreases (for RR <1) for a 1 unit change in the predictor. For binary variables the RR represents how the event rate differs between the two categories. bDMARDs: biologic DMARDs; DAS28: disease activity score for 28 joints; JAKi: Janus kinase inhibitors
Figure 3.
Figure 3.
Cumulative proportion of patients discontinuing glucocorticoid among glucocorticoid users at baseline. bDMARDs: biologic DMARDs; JAKi: Janus kinase inhibitors
See this image and copyright information in PMC

References

    1. Aletaha D, Smolen JS.. Diagnosis and management of rheumatoid arthritis: a review. JAMA 2018;320:1360–72. - PubMed
    1. Smolen JS, Landewé RBM, Bergstra SA. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis 2023;82:3–18. - PubMed
    1. Fraenkel L, Bathon JM, England BR. et al. 2021 American college of rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol 2021;73:1108–23. - PubMed
    1. Adami G, Saag KG.. Glucocorticoid-induced osteoporosis: 2019 concise clinical review. Osteoporosis Int 2019;30:1145–56. https://doi.org/10.1007%2Fs00198-019-04906-x - PubMed
    1. George MD, Baker JF, Winthrop K. et al. Risk for serious infection with low-dose glucocorticoids in patients with rheumatoid arthritis: a cohort study. Ann Intern Med 2020;173:870–8. - PMC - PubMed

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