DMARD Treatments for RA Demonstrate Comparable Efficacy  

Hands Of Woman Deformed From Rheumatoid Arthritis holding pills
Hands Of Woman Deformed From Rheumatoid Arthritis holding pills
The real-world effectiveness of different second-line therapies – TNFi, abatacept, IL-6 inhibitors, and JAK inhibitors – were compared in an observational cohort study.

Patients with rheumatoid arthritis (RA) had similar retention and response rates with 4 different biologic or targeted synthetic disease-modifying antirheumatic drug (DMARD) treatments; however, the rates of discontinuation were slightly higher for 2 of the treatments due to adverse events, according to study findings published in Annals of the Rheumatic Diseases.

Researchers conducted an observational cohort study including patients with RA in whom they assessed response, retention, and discontinuation rates to 4 different treatments — tumor necrosis factor inhibitors (TNFi) , abatacept, interleukin 6 inhibitors (IL-6i), and Janus kinase inhibitors (JAKi). Data were collected from 19 registers, 13 of which provided information on treatment response, 17 of which provided discontinuation information, and 2 of which provided only aggregated data.

The researchers used the Clinical Disease Activity Index (CDAI) to calculate response rates after 1 year of treatment. They also analyzed the reasons for treatment discontinuation as well as the rate of discontinuation for each of the treatment groups.

A total of 31,846 treatment courses (17,522 TNFi, 2775 abatacept, 3863 IL-6i, and 7686 JAKi) were included in the study.

Response rates for each of the 4 treatment types measured the percentage of RA disease remission and percentage of patients achieving low disease activity (LDA) scores on the CDAI. Researchers noted remission rates of 16% in both the TNFi and IL-6i groups, 15% in the JAKi group, and 12% in the abatacept group. A total of 54% of participants in the TNFi group, 55% in the IL-6i group, 56% in the JAKi group, and 50% in the abatacept group achieved LDA after 1 year of treatment.

When comparing TNFi to the other 3 treatments, responses only to TNFi and abatacept treatments significantly differed for both disease remission (difference: -4.6%; 95% CI, -6.7% to -1.3%) and LDA (difference -3.9%; 95% CI, -8.9 to -1.1%).

The researchers calculated similar median drug retention rates of 1.68 years for TNFi, 1.58 years for abatacept, 1.88 years for IL-6i, and 1.19 years for JAKi.

The main reason for treatment discontinuation was lack of efficacy. The researchers noted that patients were less likely to discontinue JAKi (adjusted hazard ratio [aHR], 0.75; 95% CI, 0.67-0.83) and IL-6i (aHR, 0.76; 95% CI, 0.67-0.85) treatments due to ineffectiveness compared with TNFi; however, discontinuation of abatacept vs TNFi did not differ significantly.

Study results showed that JAKi and IL-6i caused more adverse events than TNFi and abatacept, especially among women or older patients. While patients with RA were less likely to discontinue JAKi and IL-6i for ineffectiveness, they were more likely to discontinue JAKi (aHR, 1.16; 95% CI, 1.03-1.33) and IL-6i (aHR, 1.09; 95% CI, 0.85-1.03) due to adverse events.

Study limitations included lack of treatment randomization that led to confounding, use of meta-analysis combining national estimates, which restricted assessment of factors influencing efficacy, lack of safety assessment related to adverse events that caused drug discontinuation, the observation design of the study, and the fact that all JAKi agents were combined into 1 group instead of each being evaluated separately.

“In this large international collective of registers, we found similar overall drug retention rates between treatment groups,” the study authors said. “Our results support the use of these [4] treatments for…patients with RA in ‘real-world’ clinical care, underscoring their similar effectiveness.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Lauper K, Iudici M, Mongin D, et al. 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. Ann Rheum Dis. Published online June 15, 2022. doi:10.1136/annrheumdis-2022-222586