Effectiveness of JAK Inhibitors Compared With Biologic Disease-Modifying Antirheumatic Drugs on Pain Reduction in Rheumatoid Arthritis: Results From a Nationwide Swedish Cohort Study

Abstract

Objective: To compare the effectiveness of JAK inhibitors (JAKis) and biologic disease-modifying antirheumatic drugs (bDMARDs) on pain in patients with rheumatoid arthritis.

Methods: In this retrospective study, we investigated patients with a diagnosis of rheumatoid arthritis, starting treatment with a JAKi (n = 1,827), a tumor necrosis factor inhibitor (TNFi; n = 6,422), an interleukin-6 inhibitor (n = 887), abatacept (n = 1,102), or rituximab (n = 1,149) in 2017 to 2019, using data from several linked Swedish national registers. Differences in change in pain, assessed with a visual analog scale (0-100 mm), from baseline to 3 months, as well as proportions of patients remaining on initial treatment with low pain (visual analog scale pain <20) at 12 months, were compared between treatments. Comparisons of treatment responses between JAKis and bDMARDs were evaluated using multivariable linear regression, adjusted for patient characteristics, comorbidities, current comedication, and previous treatment.

Results: JAKi treatment was associated with a greater decrease in pain at 3 months compared with TNFi treatment (adjusted mean additional decrease 4.0 mm; 95% confidence interval 1.6-6.3), with similar trends in comparisons with non-TNFi bDMARDs. More patients achieved low pain at 12 months on JAKis compared with TNFis, in particular among those previously treated with at least two bDMARDs (adjusted change contrast 5.3 percentage points; 95% confidence interval 1.0-9.6).

Conclusion: JAKis had a slightly better effect on pain outcomes at 3 and 12 months compared with TNFis, with significantly greater differences in patients previously treated with at least two bDMARDs. The effect of JAKis on pain reduction was at least similar to that of non-TNFi bDMARDs.

Figure 1

Fully adjusted differences in mean change in pain from baseline to 3‐months follow‐up. Multivariate linear regression with JAK inhibitor as reference. Adj. for demographics, RA characteristics, current and previous RA treatment, and further for comorbidities. Adj., adjusted; IL‐6, interleukin‐6; RA, rheumatoid arthritis; TNF, tumor necrosis factor.

Figure 2

Fully adjusted differences in proportions attaining low pain score at 12 months. Multivariate linear regression with JAK inhibitor as reference. Adj. for demographics, RA characteristics, current and previous RA treatment, and further for comorbidities. Low pain: visual analog scale pain <20. Adj., adjusted; IL‐6, interleukin‐6; RA, rheumatoid arthritis; TNF, tumor necrosis factor.

Figure 3

Differences in mean change in pain from baseline to 3 months, stratified by line of treatment. Univariate and multivariate linear regression with JAK inhibitor as reference. Adjustment for demographics, RA characteristics, current and previous RA treatment, and further for comorbidities. Adj., adjusted; b/tsDMARD, biologic/targeted synthetic disease‐modifying antirheumatic drug; IL‐6, interleukin‐6; RA, rheumatoid arthritis; Ref, reference; TNF, tumor necrosis factor.