Effectiveness of Cycling JAKi Compared to Switching to bDMARD in Patients Who Failed a First JAKi in an International Collaboration of Registries of Rheumatoid Arthritis Patients (the JAK-pot Study)

Manuel Pombo-Suarez¹, Carlos Sanchez-Piedra², Juan J Gomez-Reino³, Kim Lauper⁴, Nevsun Inanc⁵, Anja Strangfeld⁶, Doreen Huschek⁷, Karel Pavelka⁸, Eirik Kristianslund⁹, Tore Kvien¹⁰, Ziga Rotar¹¹, Dan Nordström¹², Denis Choquette¹³, Ori Elkayam¹⁴, Burkhard Leeb¹⁵, Maria José Santos¹⁶, Kimme Hyrich¹⁷, Lianne Kearsley-Fleet¹⁸, Catalin Codreanu¹⁹, Denis Monguin²⁰, Delphine Courvoisier²⁰ and Axel Finckh²¹, ¹Rheumatology Service, Hospital Clinico Universitario, Santiago De Compostela, Santiago de Compostela, Spain, ²Research Unit, Spanish Society of Rheumatology, Madrid, Spain, ³Hospital Clínico Universitario, Santiago de Compostela, Spain, ⁴Geneva University Hospitals, Geneve, Switzerland, ⁵Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey, ⁶Deutsches Rheuma-Forschungszentrum Berlin, Berlin, Germany, ⁷Epidemiology and Health Services Research, German Rheumatism Research Center, Berlin, Germany, Berlin, Germany, ⁸Institute of Rheumatology, Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic, ⁹Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway, Oslo, Norway, ¹⁰Diakonhjemmet Hospital, Oslo, Norway, ¹¹Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia, ¹²Division of Internal Medicine and Rheumatology, Helsinki University Hospital, Helsinki, Finland, ¹³Institut de Rhumatologie de Montréal, Montréal, QC, Canada, ¹⁴Tel Aviv Medical Center, Tel Aviv, Israel, ¹⁵Karl Landsteiner University for Health Sciences, Krems/Donau, Karl Landsteiner Institute for Clinical Rheumatology, Hollabrunn, Austria, ¹⁶Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal, ¹⁷University of Manchester, Manchester, United Kingdom, ¹⁸Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom, ¹⁹Center of Rheumatic Diseases, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania, ²⁰Division of Rheumatology, Geneva University Hospital, Geneva, Switzerland, ²¹University Hospital of Geneva, Geneve - Vesenaz, Switzerland

Meeting: ACR Convergence 2021

Keywords: Disease-Modifying Antirheumatic Drugs (Dmards), registry, rheumatoid arthritis

Session Information

Date: Monday, November 8, 2021

Title: Abstracts: RA – Treatments II: New Findings in Established Therapies (1442–1445)

Session Type: Abstract Session

Session Time: 2:00PM-2:15PM

Background/Purpose: With the arrival of new Janus kinase inhibitors (JAKi), with different JAK inhibition profiles, there is the possibility of using a second JAKi in the event of failure to a first JAKi in patients with rheumatoid arthritis (RA). There are no data on the effectiveness of cycling JAKi compared to switching to biologic disease-modifying antirheumatic drug (bDMARD) in patients who have failed a first JAKi. The objective of this study is to compare the effectiveness of cycling JAKi vs switching to bDMARD in a real-world RA population.

Methods: Nested cohort study within an international collaboration of RA registries (data contributed from 14 national registries of the JAK-pot collaboration). We pooled prospectively collected data from RA patients who failed a first JAKi and were subsequently treated with either a second JAKi (JAKi cycling) or with a bDMARD (switching) in routine care. We compared the effectiveness of both strategies in terms of drug retention and in terms of disease activity (DAS28) evolution over 1 year after second treatment initiation. Differences in drug survival rates were assessed by Log Rank Test. DAS28 trajectories were predicted based on an age- and gender-adjusted linear mixed model with a quadratic trend over time.

Results: 708 patients who failed JAKi were included. 154 cycled to a second JAKi and 554 switched to a bDMARD (Table 1). Patients cycling JAKi were older, had longer disease duration, had received more bDMARDs and had longer exposure to first JAKi treatment than switchers to a bDMARD. Monotherapy was more prevalent and discontinuation of the first JAKi was more common for safety reasons than for lack of effectiveness. Cycling and switching strategies showed similar drug survival rates after two years of follow-up (Figure 1). Nevertheless, a non-significant trend emerged where discontinuation was more likely among patients cycling JAKi when reason for stopping the first JAKi was an adverse event, whereas discontinuation was less likely among patients cycling JAKi when reason for stopping the first JAKi was ineffectiveness. DAS28 over time evolved in a similar way between patients cycling JAKi and switching to a bDMARD, with improvements after one year of follow-up (Figure 2).

Conclusion: After failing a first JAKi, cycling JAKi versus switching to a bDMARD appears to have similar effectiveness despite a more difficult to treat patient profile for the patients cycling to JAKi.

Disclosures: M. Pombo-Suarez, MSD, 1, SANOFI, 6, Janssen, 6, Lilly, 6; C. Sanchez-Piedra, None; J. Gomez-Reino, Pfizer Inc, 2, 5, Biogen, 2, 5, Gilead Sciences, 2, 5, Eli Lilly, 2, 5, MSD, 2, 5, Roche, 2, 5; K. Lauper, Gilead Galapagos, 6, Viatris, 6; N. Inanc, Abbvie, 6, Lilly, 6, MSD, 6, Novartis, 6, Pfizer, 6, Roche, 6, Amgen, 6, Celltrion, 6, UCB, 6; A. Strangfeld, Pfizer, 6, Roche, 6, MSD, 6, BMS, 6, Abbvie, 6, Celltrion, 6; D. Huschek, None; K. Pavelka, Abbvie, 6, UCB, 6, MSD, 6, Roche, 6, Pfizer, 6, Eli Lilly, 6, Egis, 6, Biogen, 6, Pfizer, 6; E. Kristianslund, None; T. Kvien, Biogen, 6, Celltrion, 6, Egis, 6, Eli Lilly, 6, Evapharma, 6, Ewopharma, 6, Gilead, 6, Hikma, 6, Mylan, 6, Oktal, 6, Sandoz, 6, Sanofi, 6, Abbvie, 5, 6, BMS, 5, MSD, 5, Novartis, 5, 6, Pfizer, 5, 6, Amgen, 5, 6, UCB, 5; Z. Rotar, Abbvie, 6, Eli Lilly, 6, MSD, 6, Novartis, 6, Pfizer, 6, Roche, 6, Sandoz, 6, UCB, 6; D. Nordström, Abbvie, 6, BMS, 6, Lilly, 6, MSD, 6, Novartis, 6, Pfizer, 6, Roche, 6, UCB, 6, Celgene, 5; D. Choquette, AbbVie, 2, 5, Amgen, 2, 5, Celltrion, 2, Eli Lilly, 2, Novartis, 2, 5, Pfizer Inc, 2, 5, Sandoz, 2, 5, Sanofi, 2, 5, Teva Pharmaceuticals, 2, Gilead Sciences, 2; O. Elkayam, NOVARTIS, 1, 2, 6, Pfizer, 1, 2, 5, 6, Lilly, 1, 2, 6, Abbvie, 1, 6, BI, 1, 6; B. Leeb, Abbvie, 2, 6, Lilly, 2, 6, Pfizer, 2, 6, Janssen-Cilag, 2, Morphosys, 2, Biogen, 2, 6, Novartis, 2, Sandoz, 6, Roche, 6, Grünenthal, 6, Celgene, 6; M. José Santos, Abbvie, 6, Novartis, 6, Pfizer, 6, Roche, 6; K. Hyrich, Abbvie, 6, Pfizer, 5, BMS, 5; L. Kearsley-Fleet, None; C. Codreanu, AbbVie, 1, 6, Amgen, 1, 6, Ewopharma, 6, Lilly, 6, Novartis, 1, 6, Pfizer, 1, 6; D. Monguin, None; D. Courvoisier, Medtalks Switzerland, 6; A. Finckh, Eli Lilly, 5, 6, Pfizer Inc, 2, 5, 6, AbbVie, 2, 5, UCB, 2, Roche, 2, Galapagos, 5, MSD, 2, A2 Biotherapeutics, 2, Bristol-Myers Squibb, 2, 5.

To cite this abstract in AMA style:

Pombo-Suarez M, Sanchez-Piedra C, Gomez-Reino J, Lauper K, Inanc N, Strangfeld A, Huschek D, Pavelka K, Kristianslund E, Kvien T, Rotar Z, Nordström D, Choquette D, Elkayam O, Leeb B, José Santos M, Hyrich K, Kearsley-Fleet L, Codreanu C, Monguin D, Courvoisier D, Finckh A. Effectiveness of Cycling JAKi Compared to Switching to bDMARD in Patients Who Failed a First JAKi in an International Collaboration of Registries of Rheumatoid Arthritis Patients (the JAK-pot Study) [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/effectiveness-of-cycling-jaki-compared-to-switching-to-bdmard-in-patients-who-failed-a-first-jaki-in-an-international-collaboration-of-registries-of-rheumatoid-arthritis-patients-the-jak-pot-study/. Accessed .

« Back to ACR Convergence 2021

ACR Meeting Abstracts - https://acrabstracts.org/abstract/effectiveness-of-cycling-jaki-compared-to-switching-to-bdmard-in-patients-who-failed-a-first-jaki-in-an-international-collaboration-of-registries-of-rheumatoid-arthritis-patients-the-jak-pot-study/