Addition of Antimalarials May Increase bDMARD, JAK Inhibitor Persistence in RA

Among patients with rheumatoid arthritis (RA) receiving biologic disease-modifying antirheumatic drugs (bDMARD) or Janus kinase inhibitors (JAKis), the addition of antimalarials to the treatment regimen may reduce the incidence of adverse events (AE), according to study results published in Rheumatology.

Research has shown that the addition of antimalarials to bDMARDs or JAKis may reduce infection and cardiovascular events risks. However, little is known about the safety profile of antimalarials in this association.

Researchers aimed to assess the safety and efficacy of antimalarials in patients with RA receiving treatment with bDMARDs and JAKis.

Data were collected from the BiobadaBrasil registry, which included patients from 32 centers diagnosed with RA, according to the 1987 American College of Rheumatology (ACR) criteria. Patients enrolled from January 2009 to October 2019 were followed-up for up to 6 visits.

The primary study outcome was incidence of serious AEs (SAE). Secondary outcomes included fatal or any AEs, incidence of serious and total infections, system-specific AEs, and treatment interruption due to AEs.

A total of 1316 patients were included in the study, 280 of whom received treatment with antimalarials. Mean duration of follow-up per treatment course was 2.87 years. Patients receiving antimalarials had shorter disease duration and were more likely to smoke. Antimalarial use decreased over treatment course.

Use of antimalarials was associated with reduced risk for SAEs (multivariate incidence rate ratio [mIRR], 0.49; P <.001), total AEs (mIRR, 0.68; P <.001), total and serious infections (mIRR, 0.53; P =.007), and hepatic and pulmonary-related adverse events (mIRR, 0.21; P =.028).

Antimalarial treatment was also associated with lower risk for treatment interruption. No increase in risk for cardiovascular-related AEs was observed.

Results suggested antimalarial treatment may provide a protective effect against SAEs across varying subgroups.

The study was limited by possible selection bias, the fact that not all AEs were prospectively recorded, and the limited generalizability of the cohort.

Researchers concluded, “Our results suggest that the concomitant use of [antimalarials] along with bDMARDs or JAKi improves the overall safety and persistence of treatment in patients receiving advanced forms of treatment for RA. Further studies performed in different clinical and socio-demographic settings are needed to confirm these findings.”