Effectiveness of TNF-inhibitors, abatacept, IL6-inhibitors and JAK-inhibitors in 31 846 patients with rheumatoid arthritis in 19 registers from the 'JAK-pot' collaboration

Kim Lauper, Michele Iudici, Denis Mongin, Sytske Anne Bergstra, Denis Choquette, Catalin Codreanu, René Cordtz, Diederik De Cock, Lene Dreyer, Ori Elkayam, Ellen-Margrethe Hauge, Doreen Huschek, Kimme L Hyrich, Florenzo Iannone, Nevsun Inanc, Lianne Kearsley-Fleet, Eirik Klami Kristianslund, Tore K Kvien, Burkhard F Leeb, Galina LukinaDan C Nordström, Karel Pavelka, Manuel Pombo-Suarez, Ziga Rotar, Maria Jose Santos, Anja Strangfeld, Patrick Verschueren, Delphine Sophie Courvoisier, Axel Finckh

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21 Citations (Scopus)


BACKGROUND: JAK-inhibitors (JAKi), recently approved in rheumatoid arthritis (RA), have changed the landscape of treatment choices. We aimed to compare the effectiveness of four current second-line therapies of RA with different modes of action, since JAKi approval, in an international collaboration of 19 registers.

METHODS: In this observational cohort study, patients initiating tumour necrosis factor inhibitors (TNFi), interleukin-6 inhibitors (IL-6i), abatacept (ABA) or JAKi were included. We compared the effectiveness of these treatments in terms of drug discontinuation and Clinical Disease Activity Index (CDAI) response rates at 1 year. Analyses were adjusted for patient, disease and treatment characteristics, including lines of therapy and accounted for competing risk.

RESULTS: We included 31 846 treatment courses: 17 522 TNFi, 2775 ABA, 3863 IL-6i and 7686 JAKi. Adjusted analyses of overall discontinuation were similar across all treatments. The main single reason of stopping treatment was ineffectiveness. Compared with TNFi, JAKi were less often discontinued for ineffectiveness (adjusted HR (aHR) 0.75, 95% CI 0.67 to 0.83), as was IL-6i (aHR 0.76, 95% CI 0.67 to 0.85) and more often for adverse events (aHR 1.16, 95% CI 1.03 to 1.33). Adjusted CDAI response rates at 1 year were similar between TNFi, JAKi and IL-6i and slightly lower for ABA.

CONCLUSION: The adjusted overall drug discontinuation and 1 year response rates of JAKi and IL-6i were similar to those observed with TNFi. Compared with TNFi, JAKi were more often discontinued for adverse events and less for ineffectiveness, as were IL-6i.

Original languageEnglish
Article number222586
Pages (from-to)1358-1366
Number of pages9
JournalAnnals of the Rheumatic Diseases
Issue number10
Publication statusPublished - Oct 2022

Bibliographical note

Publisher Copyright:

Copyright 2023 Elsevier B.V., All rights reserved.


  • Abatacept/therapeutic use
  • Antirheumatic Agents/therapeutic use
  • Arthritis, Rheumatoid/chemically induced
  • Humans
  • Interleukin-6
  • Janus Kinase Inhibitors/therapeutic use
  • Treatment Outcome
  • Tumor Necrosis Factor Inhibitors
  • Tumor Necrosis Factor-alpha


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