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Are JAKis more effe...
Are JAKis more effective among elderly patients with RA, smokers and those with higher cardiovascular risk? A comparative effectiveness study of b/tsDMARDs in Sweden.
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- Bower, Hannah (author)
- Karolinska Institute,Karolinska Institutet,Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden.
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- Frisell, Thomas (author)
- Karolinska Institute,Karolinska Institutet,Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden.
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- di Giuseppe, Daniela (author)
- Karolinska Institute,Karolinska Institutet,Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden.
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- Delcoigne, Benedicte (author)
- Karolinska Institute,Karolinska Institutet,Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden.
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- Lindström, Ulf (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för reumatologi och inflammationsforskning,Institute of Medicine, Department of Rheumatology and Inflammation Research,Univ Gothenburg, Inst Med, Sahlgrenska Acad, Dept Rheumatol & Inflammat Res, Gothenburg, Sweden.,Sahlgrenska Academy
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- Turesson, Carl (author)
- Lund University,Lunds universitet,Reumatologi,Forskargrupper vid Lunds universitet,Rheumatology,Lund University Research Groups
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- Chatzidionysiou, Katerina (author)
- Karolinska Institutet,Karolinska Univ Hosp, Rheumatol Theme Inflammat & Ageing, Stockholm, Sweden.,Karolinska University Hospital
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- Lindqvist, Elisabet (author)
- Lund University,Lunds universitet,Reumatologi och molekylär skelettbiologi,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Lund Arthritis Research Group (LARG),Forskargrupper vid Lunds universitet,Rheumatology,Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Lund University Research Groups
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- Knight, Ann (author)
- Uppsala University,Uppsala universitet,Reumatologi
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- Forsblad d'Elia, Helena, 1961 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin,Institutionen för medicin, avdelningen för reumatologi och inflammationsforskning,Institute of Medicine,Institute of Medicine, Department of Rheumatology and Inflammation Research,Univ Gothenburg, Inst Med, Sahlgrenska Acad, Dept Rheumatol & Inflammat Res, Gothenburg, Sweden.,Sahlgrenska Academy
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- Askling, Johan (author)
- Karolinska Institute,Karolinska Institutet,Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden.;Karolinska Univ Hosp, Rheumatol Theme Inflammat & Ageing, Stockholm, Sweden.,Karolinska University Hospital
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Karolinska Institutet Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden (creator_code:org_t)
- BMJ Publishing Group Ltd, 2023
- 2023
- English.
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In: RMD open. - : BMJ Publishing Group Ltd. - 2056-5933. ; 9:4
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Abstract
Subject headings
Close
- To investigate whether the relative effectiveness of janus kinase inhibitors (JAKis) versus tumour necrosis factor inhibitors (TNFi) or other biological disease-modifying antirheumatic drugs in rheumatoid arthritis differ by the presence or absence of risk factors for cardiovascular (CV) disease, age, sex and smoking.Through Swedish registers, we identified 13493 individuals with 3166 JAKi, 5575 non-TNFi and 11 286 TNFi treatment initiations 2016-2022. All lines of therapy were included, with the majority in second line or higher. Treatment response was defined as the proportion reaching European Alliance of Associations for Rheumatology (EULAR) good response and Clinical Disease Activity Index (CDAI) remission, respectively, within 6 months. Crude percentage point differences in these proportions (JAKis, and non-TNFis, vs TNFis) overall and by risk factors were observed, and adjusted for confounders using linear regression models. Predicted probabilities of response and remission were estimated from adjusted Poisson models, and presented across CV risk and age.Overall, adjusted percentage point differences indicated higher response (+5.0%, 95% CI 2.2% to 7.9%) and remission (+5.8%, 95% CI 3.2% to 8.5%) with JAKis versus TNFis. The adjusted percentage point differences for response in those above 65, at elevated CV risk, and smokers were +5.9% (95% CI 2.7% to 9.0%), +8.3% (95% CI 5.3% to 11.4%) and +6.0% (95% CI 3.3% to 8.7%), respectively. The corresponding estimates for remission were +8.0% (95% CI 5.3% to 10.8%), +5.6% (95% CI 3.0% to 8.2%) and +7.6% (95% CI 5.5% to 9.7%).As used in clinical practice, response and remission at 6 months with JAKis are higher than with TNFi. Among patients with risk factors of concern, effectiveness is similar or numerically further increased. For individualised benefit-to-risk ratios to guide treatment choice, safety and effectiveness in specific patient segments should be considered.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reumatologi och inflammation (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Rheumatology and Autoimmunity (hsv//eng)
Keyword
- Humans
- Aged
- Sweden
- epidemiology
- Janus Kinase Inhibitors
- Smokers
- Cardiovascular Diseases
- epidemiology
- etiology
- Risk Factors
- Tumor Necrosis Factor-alpha
- Tumor Necrosis Factor Inhibitors
- Heart Disease Risk Factors
- Arthritis
- Arthritis, Rheumatoid
- Biological Therapy
- Epidemiology
Publication and Content Type
- ref (subject category)
- art (subject category)
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Bower, Hannah
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Frisell, Thomas
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di Giuseppe, Dan ...
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Delcoigne, Bened ...
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Lindström, Ulf
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Turesson, Carl
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Chatzidionysiou, ...
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Lindqvist, Elisa ...
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Knight, Ann
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Forsblad d'Elia, ...
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Askling, Johan
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Rheumatology and ...
- Articles in the publication
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RMD open
- By the university
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University of Gothenburg
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Karolinska Institutet
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Uppsala University
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Lund University