AB0412 CYCLING OF JAK-INHIBITORS IN PATIENTS WITH RHEUMATOID ARTHRITIS: A SINGLE-CENTRE EXPERIENCE

Abstract

BackgroundDespite the availability of multiple effective disease-modifying antirheumatic drugs (DMARDs), discontinuation/switching of treatment is common for many patients with rheumatoid arthritis (RA). Janus kinase (JAK) inhibitors or JAKi, are the latest class of DMARDs approved for RA. Data on the outcomes of cycling JAKi in RA patients is still limited to this day.ObjectivesTo assess the outcomes of switching between JAKi baricitinib, tofacitinib and upadacitinib in a real-world cohort of RA patients.MethodsThis was a hospital-based, retrospective observational study of all RA patients treated in a single-centre. Data was collected between 2016 and 2021 for all patients who failed JAKi and were treated with another JAKi. Demographic data, antibody status, history of DMARD use and clinical outcomes were assessed according to change in disease activity scores, time to JAKi discontinuation and reason for switching based on DAS 28-CRP scores.ResultsWe identified 26 RA patients, 23 (88%) of which were RhF and/or anti-CCP positive, that failed JAKi and were cycled to another JAKi. 23 (88%) patients had failed treatment with one or more biological therapies prior to initiating JAKi. 13 (50%) patients were prescribed baricitinib and the other 13 patients Tofacitinib as their initial JAKi. During their RA treatment pathway, 9 (35%) of the patients on tofacitinib switched to baricitinib, and 4 (15%) switched to upadacitinib. 7 (27%) patients who started on baricitinib were switched to upadacitinib, and 6 (23%) were switched to tofacitinib. 3 (12%) patients cycled between all 3 JAKi. Reasons for switching first JAKi included primary treatment failure at initial 3-month rescore due to lack of efficacy (7/26; 27%), secondary failure (9/26; 35%), adverse drug reactions (ADR) (2/26; 8%) and others (1/26; 4%). Additionally, 7 (27%) patients on tofacitinib were switched following a drug safety update published by the Medicines and Healthcare products Regulatory Agency (MHRA), in an effort to minimize risk of major adverse cardiovascular events and malignancies. The median time to switching first JAKi was 11.5 months (range 3-23 months). After switching JAKi, 17 (65%) patients were found to have improved DAS 28-CRPs at their 3-month rescore and continued treatment with their second JAKi. Following their switch, a total of 8 (31%) patients stopped their second JAKi due to inefficacy, 3 (12%) due to ADRs and 2 (8%) for other reasons. Of the 3 patients that went on to receive treatment with a 3rd JAKi (2/3 for primary failure; 1/3 for secondary failure), 2 patients were found to improve at their 3-month rescore.ConclusionCycling through JAKi is an appropriate and safe treatment strategy in RA patients that discontinue first JAKi therapy due to lack of efficacy or ADR.ReferencesNADisclosure of InterestsNone declared