Certolizumab Pegol Shows a Higher Retention Rate Compared to JAK Inhibitors in Patients with Rheumatoid Arthritis, Regardless of Baseline Rheumatoid Factor Levels. A Multicenter Retrospective Study.

Mitndbaim Parra¹, Rafaela Ortega-Castro², Jerusalén Calvo³, Francisco Jose Cepas⁴, Montserrat Robustillo-Villarino⁵, Andres Zuniga-Vera⁵, Ana Martinez-Feito⁶, Chamaida Plasencia-Rodríguez⁷, Ester Costa-Moya⁸, Delia Taverner-Torrent⁸, Luis Sainz Comas⁹, Cesar Diaz-Torne⁹, Virginia Ruiz-Esquide¹⁰, Cynthia Rojas¹¹, Lourdes Martin-de la Sierra Lopez¹², Laura Jimenez-Rodriguez¹², David Velasco-Sanchez¹², Regina Fará Garcia¹³, Antonio Juan-Mas¹⁴, Marina soledad Moreno Garcia¹⁵, Ana Valeria Acosta Alfaro¹⁶, Santiago Muñoz¹⁷, Maria Martín López¹⁸, Raquel Zas¹⁹, FRANCISCO JAVIER GODOY NAVARRETE²⁰, Isabel Anon Onate²¹, Fernando Ortiz-Márquez²², Natalia Mena Vázquez²³, Paula Estrada-Alarcón²⁴, Lourdes Ladehesa²⁵, Alejandro Escudero Contreras³ and Clementina López Medina²⁶, ¹¹. Rheumatology Department, Reina Sofía University Hospital, Cordoba/IMIBIC/University of Cordoba., Cordoba, Spain, ²Rheumatology service/Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC)/ Reina Sofia University Hospital/ University of Cordoba, Spain, Cordoba, Andalucia, Spain, ³IMIBIC / Reina Sofia Hospital / University of Cordoba, Córdoba, Spain, ⁴University of Cordoba, Cordoba, Spain, ⁵Department of Rheumatology, Hospital Universitario de la Plana, Vila-real, Castellón, Spain, Vila-real, Castellón, Spain, ⁶Hospital Universitario La Paz, Madrid, Madrid, Spain, ⁷Hospital Universitario La Paz, MADRID, Spain, ⁸Hospital Sant Joan Reus, Reus, Spain, ⁹Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, ¹⁰Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain, ¹¹Hospital Clinic, Barcelona, Spain, ¹²Hospital General Universitario de Ciudad Real, Ciudad Real, Spain, ¹³Hospital Son Llàtzer, Palma, Spain, ¹⁴Son Llazter University Hospital, Madrid, Spain, ¹⁵Hospital Universitario Miguel Servet, Zaragoza, Spain, ¹⁶Hospital Universitario Infanta Sofia; Universidad Europea de Madrid; FIIB HUIS-HUHEN, Madrid, Spain, ¹⁷Hospital Universitario Infanta Sofía;Universidad Europea de Madrid. Faculty of Medicine, Health and Sports. Department of Medicine; FIIB HUIS-HUHEN, Madrid, Spain, ¹⁸Hospital ¹² de Octubre, Madrid, Spain, ¹⁹Hospital Universitario Doce de Octubre, Madrid, Spain, ²⁰Jaen University Hospital, Spain, Jaen, Spain, ²¹Hospital Universitario de Jaén, Jaén, Spain, ²²Department of Rheumatology, Hospital Regional Universitario de Málaga, Málaga, Spain, Malaga, Spain, ²³Hospital Regional Universitario de Malaga, Malaga, Spain, Málaga, Spain, ²⁴Hospital de San Juan Despí Moisès Broggi, Barcelona, Spain, ²⁵IMIBIC-Reina Sofia Hospital-University of Cordoba, Cordoba, Spain, Cordoba, Spain, ²⁶Department of Medicine, Hospital Universitario Reina Sofia, University of Cordoba, IMIBIC, Cordoba, Spain

Meeting: ACR Convergence 2025

Keywords: Anti-TNF Drugs, rheumatoid arthritis, Rheumatoid Factor

Session Information

Date: Sunday, October 26, 2025

Title: (0470–0505) Rheumatoid Arthritis – Treatment Poster I

Session Type: Poster Session A

Session Time: 10:30AM-12:30PM

Background/Purpose: Rheumatoid factor (RF) is an antibody directed against the Fc fragment of IgG that plays a key role in the development of rheumatoid arthritis (RA). Elevated RF levels have been associated with greater disease severity and higher cardiovascular risk. In this context, patients with high RF levels may present a higher inflammatory burden and a lower response to JAK inhibitors (JAKi), possibly due in part to the use of these drugs at low doses. However, previous studies have shown that certolizumab pegol (CZP) offers comparable efficacy in patients with both high and low RF levels.The objectives of this study were: a) to compare, in RA patients with high RF levels, the efficacy of CZP vs. JAKi after 12 months of treatment and b) to compare the drug retention rate between both groups after 3 years of follow-up.

Methods: Longitudinal, retrospective, multicenter study including RA patients treated with CZP or JAKi (tofacitinib, baricitinib, upadacitinib, or filgotinib) between 2010 and 2024. Baseline RF levels and disease activity (DAS28) were collected at baseline, 6 months, and 12 months, along with treatment start and discontinuation dates. Propensity score (PS) matching was used to match CZP and JAKi groups based on age, prior use of b/tsDMARDs, and concomitant methotrexate use. Change in DAS28 was compared between groups using Student’s t-test. Log-rank tests and Kaplan-Meier curves were used to evaluate treatment retention rates in both groups according to RF levels, considering RF ≥200 IU/mL as “very high” levels.

Results: A total of 364 patients (234 CZP and 126 JAKi) with available RF titers were included. After PS matching, both groups (126 patients each) were comparable in age, sex, disease duration, baseline DAS28, concomitant methotrexate use, and prior b/tsDMARD use.In patients with RF ≥200 IU/mL, those treated with CZP showed a greater reduction in DAS28 compared to JAKi (-2.12±1.29 vs. -1.41±1.38, p=0.098), although this did not reach statistical significance. In patients with RF < 200 IU/mL, the change in DAS28 was similar between groups (-1.66±1.38 vs. -1.89±1.41, p=0.339).In patients with RF ≥200 IU/mL, the 3-year drug retention rate was significantly higher in CZP vs. JAKi (survival probability 57.6% [95%CI 43.0–77.2] vs. 7.1% [95%CI 1.9%–27.2], p < 0.001). Similarly, in patients with RF < 200 IU/mL, CZP also showed a higher retention rate (survival probability 54.8% [95%CI 45.6%–66.0%] vs. 22.5% [95%CI 15.5%–32.4%], p < 0.001).

Conclusion: In patients with high RF levels (≥200 IU/mL), CZP showed a trend toward greater clinical efficacy after 12 months compared to JAKi. In addition, CZP demonstrated a higher drug retention rate than JAKi in both high and low RF subgroups, suggesting greater persistence of CZP regardless of RF levels in the general RA patient population.

Figure 1. Three-year drug retention rate in patients with (A) RF ≥200 IU/mL and (B) RF < 200 IU/mL.

Disclosures: M. Parra: None; R. Ortega-Castro: None; J. Calvo: None; F. Cepas: None; M. Robustillo-Villarino: None; A. Zuniga-Vera: None; A. Martinez-Feito: None; C. Plasencia-Rodríguez: AbbVie/Abbott, 5, 6, Eli Lilly, 6, Novartis, 6, Pfizer, 5, 6, UCB, 6; E. Costa-Moya: None; D. Taverner-Torrent: None; L. Sainz Comas: None; C. Diaz-Torne: None; V. Ruiz-Esquide: None; C. Rojas: None; L. Martin-de la Sierra Lopez: None; L. Jimenez-Rodriguez: None; D. Velasco-Sanchez: None; R. Fará Garcia: None; A. Juan-Mas: None; M. Moreno Garcia: None; A. Acosta Alfaro: None; S. Muñoz: Janssen, 1, 2, 5, 6, 7; M. Martín López: None; R. Zas: None; F. GODOY NAVARRETE: None; I. Anon Onate: None; F. Ortiz-Márquez: None; N. Mena Vázquez: None; P. Estrada-Alarcón: None; L. Ladehesa: None; A. Escudero Contreras: None; C. López Medina: None.

To cite this abstract in AMA style:

Parra M, Ortega-Castro R, Calvo J, Cepas F, Robustillo-Villarino M, Zuniga-Vera A, Martinez-Feito A, Plasencia-Rodríguez C, Costa-Moya E, Taverner-Torrent D, Sainz Comas L, Diaz-Torne C, Ruiz-Esquide V, Rojas C, Martin-de la Sierra Lopez L, Jimenez-Rodriguez L, Velasco-Sanchez D, Fará Garcia R, Juan-Mas A, Moreno Garcia M, Acosta Alfaro A, Muñoz S, Martín López M, Zas R, GODOY NAVARRETE F, Anon Onate I, Ortiz-Márquez F, Mena Vázquez N, Estrada-Alarcón P, Ladehesa L, Escudero Contreras A, López Medina C. Certolizumab Pegol Shows a Higher Retention Rate Compared to JAK Inhibitors in Patients with Rheumatoid Arthritis, Regardless of Baseline Rheumatoid Factor Levels. A Multicenter Retrospective Study. [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/certolizumab-pegol-shows-a-higher-retention-rate-compared-to-jak-inhibitors-in-patients-with-rheumatoid-arthritis-regardless-of-baseline-rheumatoid-factor-levels-a-multicenter-retrospective-study/. Accessed .

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