Characterization of Second-Line Therapy After First JAK Inhibitor Use: Results From the CorEvitas Rheumatoid Arthritis Registry.

objectiveWe performed a real-world characterization of patients with rheumatoid arthritis (RA) who initiate a JAK inhibitor (JAKi) and switch to a subsequent therapy and examination of factors associated with the use of another JAKi/therapy with another mechanism of action (MoA).

methodsThis study included patients with RA in the US CorEvitas RA Registry who initiated a JAKi (August 16, 2019, to October 30, 2023), had prior exposure to at least one conventional synthetic disease-modifying antirheumatic drug (DMARD) and at least one biologic DMARD (bDMARD), and switched to another therapy within three months of JAKi discontinuation. Patients were classified as JAKi "cyclers" or "switchers" from JAKi to another MoA. Outcomes evaluated from JAKi initiation to cycle/switch included the Clinical Disease Activity Index (CDAI) score and patient-reported outcomes. Factors associated with switching versus cycling were identified using multivariable logistic regression models.

resultsA total of 197 patients were included: 27.9% were cyclers, and 72.1% were switchers; most had moderate/high CDAI scores and received initial JAKi as a fourth or higher line of therapy. From JAKi initiation to switch, improvements in CDAI scores/patient-reported outcomes were numerically greater for cyclers versus switchers. History (present ever/at enrollment) of hypertension was associated with higher odds, and history of fibromyalgia and prior use of two or more bDMARDs versus one bDMARD were associated with lower odds of switching versus cycling.

conclusionIn this real-world US study of patients with RA, compared with switching, cycling was observed in patients with better response to initial JAKi, a history of fibromyalgia, and prior use of two or more bDMARDs. Sample size, which was smaller in cyclers than in switchers, limited the study; larger studies are required to evaluate effectiveness.