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

Abstract

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). 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. 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). 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.