Glucocorticoid reduction with baricitinib in rheumatoid arthritis refractory to prior therapies: a 24-week real-world analysis.

Introduction: In a real-world cohort of rheumatoid arthritis (RA) patients who were unable to discontinue glucocorticoids (GCs) despite prior therapies, we aimed to evaluate the GC-sparing effect of baricitinib (BARI) and to identify clinical factors associated with GC reduction. Materials and methods: This single-center retrospective observational study included RA patients who initiated BARI while receiving systemic GCs between 2018 and 2024. Disease activity and daily GC dose were assessed at baseline and at weeks 4, 12, and 24. The primary outcome was the percent reduction in daily GC dose at week 24. Linear and logistic regression analyses were performed to identify factors associated with GC reduction and discontinuation, with two-variable multivariable models constructed to avoid overfitting. Results: Among 177 patients who initiated BARI, 39 (22%) were receiving GCs at treatment initiation and were included in the analysis. After prior exposure to biologic or targeted synthetic DMARDs in 31 patients (79%), 34 (87%) had moderate or higher disease activity by the Clinical Disease Activity Index at baseline, and 27 (69%) had comorbid interstitial lung disease. The median daily GC dose decreased from 3.0 mg/day at baseline to 1.0 mg/day at week 24 ( Conclusion: In this real-world cohort of GC-dependent RA patients with persistent disease activity and frequent ILD comorbidity despite prior therapies, BARI enabled clinically meaningful GC reduction and improved disease activity within 24 weeks. Resistance to multiple prior b/tsDMARDs emerged as a key barrier to GC tapering, highlighting the importance of introducing JAK inhibitors before progression to a difficult-to-treat state.