Abstract：
In recent years Janus kinase inhibitors (JAKi) have joined tumor necrosis factor inhibitors (TNFi) and interleukin (IL)-17 inhibitors (IL-17i) as approved disease modifying anti-rheumatic drugs (DMARD) for moderate to severe forms of axial spondyloarthritis (axSpA). Drug survival in axSpA patients has not been well studied in a real-world outpatient scenario since the approval of JAKi. We aimed to analyze the three drug classes based on modes of actions (MoA) for their persistence rates among German axSpA outpatients. A retrospective analysis of the RHADAR database for axSpA patients with a new initiation of TNFi, IL-17i, or JAKi treatment between January 2015 and October 2023 was conducted. Analyses included Kaplan-Meier curves and adjusted Cox regressions for drug discontinuation. 1222 new biological DMARD (TNFi [n = 954], IL-17i [n = 190]) or JAKi (n = 78) treatments were reported. The median drug survival was 31 months for TNFi, 25 for IL-17i, and 18 for JAKi. The corresponding 2-year drug survival rate was 79.6%, 72.6%, and 62.8% for TNFi, IL-17i, and JAKi, respectively. The probability for discontinuation for JAKi was significantly higher compared with TNFi (HR 1.91 [95% CI 1.22-2.99]) as well as for IL-17i compared with TNFi (HR 1.43 [95% CI 1.02-2.01]), possibly related to more frequent use of TNFis as first-line therapy. IL-17i and JAKi discontinuation probabilities were similar. Primary non-response was the reason for drug discontinuation in most cases across all MoA. TNFi treatment might persist longer than JAKi and IL-17i in German axSpA outpatients, possibly related to more severe or refractory disease in patients with JAKi-treated or IL-17i-treated axSpA.
摘要：
近年来，Janus激酶抑制剂（JAKi）已加入肿瘤坏死因子抑制剂（TNFi）和白介素（IL）-17抑制剂（IL-17i），已被批准为中度至重度形式的缓解疾病的抗风湿药（DMARD）轴向脊柱关节炎（axSpA）。自JAKI批准以来，在现实世界的门诊情况下，尚未对axSpA患者的药物生存进行很好的研究。我们旨在分析德国axSpA门诊患者中基于作用模式（MoA）的三种药物类别的持久性率。对axSpA患者的RHADAR数据库进行回顾性分析，IL-17i,或在2015年1月至2023年10月期间进行JAKI治疗.分析包括Kaplan-Meier曲线和药物停药的校正Cox回归。1222新的生物DMARD（TNFi[n=954]，报道了IL-17i[n=190])或JAKi(n=78)治疗。TNFi的中位药物生存期为31个月，25对于IL-17i，和18为JAKI。相应的药物2年生存率为79.6%,72.6%,TNFi为62.8%，IL-17i,还有JAKI,分别。与TNFi相比（HR1.91[95%CI1.22-2.99]），以及与TNFi相比（HR1.43[95%CI1.02-2.01]），可能与更频繁地使用TNFis作为一线治疗有关。IL-17i和JAki的停药概率相似。在所有MoA的大多数情况下，原发性无反应是停药的原因。在德国axSpA门诊患者中，TNFi治疗可能比JAKI和IL-17i持续更长时间。可能与JAKI治疗或IL-17i治疗的axSpA患者的更严重或难治性疾病有关。
