JAK-pot Study: To Cycle or Switch after JAK inhibitor Failure? Save

Data from 17 international registries (JAK-pot collaboration) suggest that for Rheumatoid arthritis (RA) patients failing their first janus kinase inhibitor (JAKi), it did not matter if they were cycled to another JAKi or switched to a biologic disease-modifying antirheumatic drug (bDMARD).

This was a nested cohort study with data pooled from 17 international registries (JAK-pot collaboration). RA were enrolled if after their first JAKi treatment failure they were subsequently treated with either a second JAKi or with a bDMARD. Primary outcomes were the change in Clinical Disease Activity Index (CDAI) over time.

A total of 365 JAKi cycling and 1635 bDMARD switching patients included.  JAKi cyclers were older and had received more prior bDMARDs.

Retention rates after 2 years of follow-up were similar, but after adjusted analysis, cycling was associated with higher retention (p=0.04). There was similar improvements in CDAI over time with both strategies.

Amongst cyclers, if the first JAKi was discontinued for an adverse event (AE), it was more likely that the second JAKi would also be stopped due to an AE.

Conclusions After failing the first JAKi, cycling JAKi and switching to a bDMARD appear to have similar effectiveness.