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DMARD treatments for rheumatoid arthritis demonstrate comparable efficacy

Patients with rheumatoid arthritis (RA) had similar retention and response rates with 4 different biological or synthetic disease-modifying antirheumatic therapies (DMARDs); however, dropout rates were slightly higher for 2 of the treatments due to adverse events, according to study results published in Annals of rheumatic diseases.

The researchers conducted an observational cohort study including patients with RA in which they assessed response, retention and dropout rates of 4 different treatments – tumor necrosis factor (TNFi) inhibitors, abatacept , interleukin 6 (IL-6i) inhibitors and Janus kinase (JAKi) inhibitors. Data were collected from 19 registers, of which 13 provided information on response to treatment, 17 provided information on discontinuation of treatment, and 2 provided only aggregated data.

The researchers used the Clinical Disease Activity Index (CDAI) to calculate response rates after 1 year of treatment. They also analyzed the reasons for discontinuation of treatment as well as the discontinuation rate for each of the treatment groups.


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A total of 31,846 courses (17,522 TNFi, 2,775 abatacept, 3,863 IL-6i and 7,686 JAKi) were included in the study.

Response rates for each of the 4 treatment types measured the percentage of RA remission and the percentage of patients achieving low disease activity (LDA) scores on the CDAI. The researchers noted remission rates of 16% in the TNFi and IL-6i groups, 15% in the JAKi group and 12% in the abatacept group. A total of 54% of participants in the TNFi group, 55% in the IL-6i group, 56% in the JAKi group, and 50% in the abatacept group achieved ADL after 1 year of treatment.

Comparing TNFi to the other 3 treatments, responses to only TNFi and abatacept treatments differed significantly for disease remission (difference: -4.6%; 95% CI, -6.7% to – 1.3%) and ADL (difference -3.9%; 95%CI, -8.9 to -1.1%).

The researchers calculated similar median retention rates of 1.68 years for TNFi, 1.58 years for abatacept, 1.88 years for IL-6i and 1.19 years for JAKi.

The main reason for stopping treatment was lack of efficacy. The researchers noted that patients were less likely to discontinue JAKi (adjusted hazard ratio [aHR], 0.75; 95% CI, 0.67-0.83) and IL-6i (aHR, 0.76; 95% CI, 0.67-0.85) due to their ineffectiveness compared to TNFi; however, discontinuation of abatacept versus TNFi was not significantly different.

Study results showed that JAKi and IL-6i caused more adverse events than TNFi and abatacept, especially in women or elderly patients. While RA patients were less likely to discontinue JAKi and IL-6i due to ineffectiveness, they were more likely to discontinue JAKi (aHR, 1.16; 95% CI, 1.03-1, 33) and IL-6i (aHR, 1.09; 95% CI, 0.85-1.03) due to adverse events.

Limitations of the study included the lack of randomization of treatment which led to confounding, the use of a meta-analysis combining national estimates, which restricted the assessment of factors influencing efficacy, lack of safety assessment related to adverse events leading to drug discontinuation, the observational design of the study, and the fact that all JAKi agents were combined into 1 group instead of being assessed separately .

“In this large international collective of registries, we found similar overall rates of medication retention between treatment groups,” the study authors said. “Our results support the use of these [4] treatments for… RA patients in “real-world” clinical care settings, highlighting their similar effectiveness. »

Disclosures: Some study authors have disclosed affiliations with biotechnology, pharmaceutical and/or device companies. Please see the original citation for a full list of author disclosures.

Reference

Lauper K, Iudici M, Mongin D, et al. Efficacy of TNF inhibitors, abatacept, IL6 inhibitors and JAK inhibitors in 31,846 patients with rheumatoid arthritis in 19 registries of the “JAK-pot” collaboration. Ann Rheum Dis. Published online June 15, 2022. doi:10.1136/annrheumdis-2022-222586