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Abstract Number: 0504

Janus Kinase Inhibitors Persist Longer Than Biologics in Rheumatoid Arthritis: Retrospective Analysis of Real-world Outpatient Data from the German Rhadar Database

Linus Maximilian Risser1, Torsten Witte2, Matthias Englbrecht3, Patrick-Pascal Strunz4, Matthias Froehlich5, Marc Schmalzing6, Michael Gernert7, Peter Bartz-Bazzanella8, Cay von Der Decken9, Kirsten Karberg10, Georg Gauler11, Susanna Spaethling-Mestekemper12, Christoph Kuhn13, Wolfgang Vorbrueggen14, Martin Welcker15 and Stefan Kleinert16, 1Hannover Medical School, Hannover, Germany, 2Dept of Immunology and Rheumatology, Hannover, Germany, 3Freelance Healthcare Data Scientist, Eckental, 4University hospital of Wuerzburg, Wuerzburg, Germany, 5Uniklinikum Wuerzburg, Medizinische Klinik II, Wuerzburg, Germany, 6University Hospital Wuerzburg, Würzburg, Germany, 7Medicine II, Division Rheumatology/Clinical Immunology, University Hospital of Wuerzburg, Wuerzburg, 8Rhein-Maas Klinikum, Wuerselen, Germany, 9Klinik für Internistische Rheumatologie, Rhein-Maas-Klinik Wuerselen, Würselen, 10Rheumatologisches Versorgungszentrum Steglitz, Berlin, Germany, 11rheumapraxis, Osnabrück, Germany, 12Rheumapraxis Muenchen, Muenchen, Germany, 13Praxis für Rheumatologie, Karlsruhe, Germany, 14Verein zur Foerderung der Rheumatologie e.V, Wuerselen, Germany, 15Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, Planegg, Germany, 16Praxisgemeinschaft Rheumatologie - Nephrologie (PGRN), Erlangen, Germany

Meeting: ACR Convergence 2024

Keywords: ,

Session Information

Date: Saturday, November 16, 2024

Title: RA – Treatment Poster I

Session Type: Poster Session A

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

Background/Purpose: Numerous biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) have been approved for treating rheumatoid arthritis (RA), including Janus kinase inhibitors (JAKi), rituximab, abatacept, interleukin-6 inhibitors (IL-6i) and tumor necrosis factor inhibitors (TNFi). Real-world data regarding treatment persistence and drug survival in the time period following the approval of JAKi are limited.

The aim of this analysis of the pseudonymized RheumaDataRhePort (Rhadar) database was to compare persistence on different bDMARDs (rituximab, abatacept, IL-6 inhibitors, TNFi) and JAKi.

Methods: We performed a retrospective analysis of the Rhadar database (Kleinert, S., P. Bartz-Bazzanella et. al. (2021). “A Real-World Rheumatology Registry and Research Consortium: The German RheumaDatenRhePort (RHADAR) Registry.” J Med Internet Res 23(5): e28164.s). RA patients who received newly prescribed therapy with a bDMARD or JAKi between January 15, 2015 and October 17, 2023 were included. We used Cox regression analysis adjusted for age, gender and disease duration to compare drug survival between the different mode of actions. The statistical analysis was performed with R (version 4.3.2) (R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2018) or RStudio (version 2023.12.0+369) (RStudio Team. RStudio: Integrated Development for R. RStudio, Inc, Boston, MA. 2016.RStudio Team. RStudio: Integrated Development for R. RStudio, Inc, Boston, MA. 2016).

Results: During the analysis period, 4678 treatments with bDMARDs (TNFi: 2237, IL-6 inhibitors: 640, Abatacept: 262, Rituximab: 165) or JAKi (1374)) were started. After 5 years, the survival rate was highest in the JAKi group (68.3%) compared to patients receiving TNFi (58.6%), IL-6 inhibitors (58.6%), abatacept (55.0%) or rituximab (53.3%). The adjusted Cox regression analysis revealed a significantly higher probability of treatment discontinuation in patients receiving rituximab (HR 1.36 [95% CI 1.06-1.74], p=0.015), abatacept (HR 1.46 [95% CI 1.18-1. 80], p< 0.001), IL-6 inhibitors (HR 1.20 [95% CI 1.02-1.42], p=0.026) or TNFi (HR 1.29 [95% CI 1.15-1.46], p< 0.001) compared to the reference group JAKi. No significant differences were found between the bDMARDs. Notably the persistence on JAKi and rituximab after two years was comparably high but then the curve of rituximab dropped (figure 1) between 24 and 36 months of therapy. 60% of the corresponding treatment discontinuations occurred between March 2020 and July 2022.

Conclusion: Persistence on JAKi after 5 years was significantly higher than on bDMARDs. An association between the lower persistence on rituximab and the COVID-19 pandemic seems likely, with increased treatment discontinuations between March 2020 and July 2022.

Supporting image 1

Figure 1: Kaplan-Meier diagram for drug survival of the different drug classes based on MoA. rituximab (CD20), abatacept (CD80/86), IL-6 inhibitors (IL-6), JAK (Janus kinase inhibitors), TNF (tumor necrosis factor inhibitors)

Disclosures: L. Risser: AbbVie/Abbott, 12, Support for attending meetings and/or travel, Biocon Germany, 12, Support for attending meetings and/or travel; T. Witte: AbbVie, 5, Amgen, 5, AstraZeneca, 6, Bristol-Myers Squibb, 5, Celgene, 5, Chugai, 5, Gilead, 5, GlaxoSmithKlein(GSK), 6, Janssen, 5, Lilly, 5, MSD, 5, Mylan, 5, Novartis, 5, Pfizer, 5, Roche, 5, UCB, 5; M. Englbrecht: AbbVie, 2, Sanofi, 6; P. Strunz: AbbVie/Abbott, 6, 12, Travel grants, Eli Lilly, 12, Travel grants, Janssen, 12, Travel grants, Roche, 5; M. Froehlich: Galapagos, 6, Novartis, 12, Travel costs; M. Schmalzing: AbbVie/Abbott, 1, 6, Amgen, 1, AstraZeneca, 1, 6, Boehringer-Ingelheim, 1, 5, 6, Celgene, 5, Chugai/Roche, 1, 5, 6, Eli Lilly, 1, EUSA-Pharma, 1, 6, Galapagos, 1, 5, 6, Gilead, 1, 6, Janssen, 1, 6, Medac, 1, 5, Mylan, 5, 6, Novartis, 1, 5, 6, onkowissen.de, 1, Sandoz, 1, UCB, 1, 5; M. Gernert: None; P. Bartz-Bazzanella: AbbVie/Abbott, 6, Boehringer-Ingelheim, 6, Eli Lilly, 6, Novartis, 5, 6; C. von Der Decken: AbbVie/Abbott, 12, Versorungssymposium 2024, Galapagos/Alphasigma, 12, DGRh-Kongress 2023 and 2024; K. Karberg: None; G. Gauler: AbbVie/Abbott, 6, Eli Lilly, 1, Novartis, 6, UCB, 6; S. Spaethling-Mestekemper: AbbVie/Abbott, 6, Boehringer-Ingelheim, 6, Eli Lilly, 6, GlaxoSmithKlein(GSK), 6, Janssen, 6, Novartis, 6, UCB, 6; C. Kuhn: None; W. Vorbrueggen: None; M. Welcker: AbbVie/Abbott, 1, 5, 6, Boehringer-Ingelheim, 1, 5, 6, Eli Lilly, 1, 6, Gilead, 1, 6, Novartis, 1, 5, 6; S. Kleinert: AbbVie/Abbott, 6, Chugai, 6, Novartis, 5, 6.

To cite this abstract in AMA style:

Risser L, Witte T, Englbrecht M, Strunz P, Froehlich M, Schmalzing M, Gernert M, Bartz-Bazzanella P, von Der Decken C, Karberg K, Gauler G, Spaethling-Mestekemper S, Kuhn C, Vorbrueggen W, Welcker M, Kleinert S. Janus Kinase Inhibitors Persist Longer Than Biologics in Rheumatoid Arthritis: Retrospective Analysis of Real-world Outpatient Data from the German Rhadar Database [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/janus-kinase-inhibitors-persist-longer-than-biologics-in-rheumatoid-arthritis-retrospective-analysis-of-real-world-outpatient-data-from-the-german-rhadar-database/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/janus-kinase-inhibitors-persist-longer-than-biologics-in-rheumatoid-arthritis-retrospective-analysis-of-real-world-outpatient-data-from-the-german-rhadar-database/