AB0414 DRUG PERSISTENCE ON JANUS KINASE (JAK) INHIBITORS COMPARED TO BIOLOGIC DMARDs IN PATIENTS WITH RHEUMATOID ARTHRITIS: RETROSPECTIVE STUDY IN THE AUSTRALIAN POPULATION

Abstract

BackgroundIn rheumatoid arthritis (RA) persistence on disease modifying anti-rheumatic drugs (DMARDs) can be interpreted as a composite measure of effectiveness, safety, and tolerability. There is limited data available on real-life use of the newest class of drugs, the Janus Kinase (JAK) inhibitors. JAK inhibitors are small-molecule treatments which are administered orally on a daily basis and offer a long-term option in RA treatment.ObjectivesTo compare drug persistence on JAK inhibitors tofacitinib, baricitinib and upadacitinib to tumor necrosis factor-α (TNF) inhibitors and other DMARDs in RA patients in Australia.MethodsA retrospective observational study was conducted among RA patients in the Australian Medicare Database (from January 2006 till October 2021), aged ≥18 and for whom a JAK inhibitor or biologic DMARDs were dispensed. Data were provided by the Australian Department of Health and Aging through PROSPECTION, an Australian healthcare consulting company. A deidentified 10% sample of the database was taken as a random representation of RA patients in Australia.Kaplan-Meier analysis was used to calculate drug persistence rates, defined as the time from treatment initiation until the date of the last dose when there had not been a script dispensed for 6 months; except for rituximab, where a 12-month gap was applied.ResultsData from 5,455 patients were analysed. For all patients the 12-month persistence rates were 61% for JAK inhibitors (baricitinib, tofacitinib, upadacitinib), 62% for tocilizumab, 52% for TNF inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab), and 51% for abatacept. The JAK inhibitors baricitinib (64%) and upadacitinib (78%) were superior to tofacitinib (54%). Median treatment persistence for upadacitinib was not reached (n = 430); was 27.1 months for baricitinib and 15.2 months for tofacitinib. For TNF inhibitors, treatment persistence was 15.1 months for adalimumab, 14.1 months for certolizumab, 14.0 months for etanercept, 11.1 months for golimumab and 4.5 months for infliximab.Persistence rates on first-line JAK inhibitors were 70% for baricitinib and 57% for tofacitinib; persistence rates dropped to 63% for baricitinib and 47% for tofacitinib in the second-line setting. First-line persistence rates were 54% for TNF inhibitors and 65% for tocilizumab, rates were sustained for tocilizumab, but dropped to 48% for TNF inhibitors in the second-line setting.ConclusionThis real-world data highlights that in an Australian clinical practice setting treatment persistence rates on 12 months on JAK inhibitors, in particular baricitinib and upadacitinib, were superior to TNF inhibitors, but not to tocilizumab. Suggesting that persistence rates might differ according to biologics mode of action and line of treatment.Table 1.Persistence rates at 12 months post treatment initiationAll patientsFirst lineSecond lineJAK inhibitorsOverall61% (2155)60% (616)60% (554)Baricitinib64% (537)70% (158)63% (124)Tofacitinib54% (1188)57% (441)47% (294)Upadacitinib78% (430)28% (17)84% (136)TNF inhibitorsOverall52% (6339)54% (4227)48% (1561)Adalimumab55% (2710)56% (2030)48% (590)Certolizumab51% (593)54% (251)47% (147)Etanercept52% (2079)55% (1354)47% (623)Golimumab49% (814)49% (506)47% (174)Infliximab35% (143)23% (86)53% (27)Other DMARDsAbatacept51% (952)56% (263)46% (310)Rituximab49% (284)41% (70)65% (79)Tocilizumab62% (1156)65% (279)65% (351)In brackets are number of patients.