PDF(Pubmed)
Abstract：
Background/Objectives: To date, the literature concerning real-world data on the retention rate and safety of Janus kinase inhibitors (JAKis) is limited. To retrospectively evaluate the overall drug retention rate (DRR) of different JAKis in a monocentric cohort of patients with rheumatoid arthritis (RA). Methods: Patients diagnosed with RA and treated with JAKis who were evaluated at our outpatient clinic from March 2017 to December 2023 were included in the study. Demographic, clinical characteristics, and comorbidities were recorded. The DRR was evaluated as the time to drug discontinuation, and baseline predictors of drug discontinuation were investigated through Cox regression after adjusting for baseline confounders. Results: The global DRR for JAKis was 51.3%. The DRR was 37.5% for tofacitinib, 46.6% for baricitinib, 69.4% for upadacitinib, and 53.5% for filgotinib. Considering all JAKis, the only significant predictor of drug discontinuation was the use of JAKis as a first-line treatment (HR 95% CI [0.25 (0.13-0.46)]. When considering each JAKi individually, a longer disease duration predicted TOF discontinuation (HR95% CI [1.05 (1.01-1.09)], while seropositivity protected against TOF being withdrawn (HR95% CI [0.41 (0.17-0.97)]. No independent predictors emerged for other JAKis. Conclusions: the use of JAKis as a first-line treatment as well as disease duration and serology may impact the DRR of JAKis, which may inform tailored treatment strategies in clinical practice.
摘要：
背景/目标：迄今为止，有关Janus激酶抑制剂(JAKis)保留率和安全性的真实世界数据的文献有限.回顾性评估类风湿关节炎（RA）患者单中心队列中不同JAKis的总体药物保留率（DRR）。方法：将2017年3月至2023年12月在我们的门诊进行评估的诊断为RA并接受JAKis治疗的患者纳入研究。人口统计,临床特征,并记录合并症。DRR被评估为停药时间，在校正基线混杂因素后,通过Cox回归研究了药物停药的基线预测因素.结果：JAKIS的全球DRR为51.3%。托法替尼的DRR为37.5%，巴利替尼的46.6%，upadacitinib为69.4%，菲尔戈替尼占53.5%。考虑到所有的JAKIS,停药的唯一显著预测因素是使用JAKis作为一线治疗(HR95%CI[0.25(0.13~0.46)].当单独考虑每个JAKI时，疾病持续时间较长预测TOF停药(HR95%CI[1.05(1.01-1.09)]，而血清阳性可防止TOF退出(HR95%CI[0.41(0.17-0.97)]。其他JAKIS没有出现独立的预测因子。结论：使用JAKis作为一线治疗以及疾病持续时间和血清学可能会影响JAKis的DRR，这可以为临床实践中量身定制的治疗策略提供信息。
