OBJECTIVES: Previous research from the real-world evidence TARDIS register indicated that IL6 inhibitors showed superior clinical response after JAKi cessation compared to other b/tsDMARDs in rheumatoid arthritis (RA). However, baseline differences in demographic and clinical variables, as well as prior exposure to advanced therapies, were observed among the treatment groups, potentially influencing the findings. Therefore, the objective was to identify factors that could predict clinical responses.

METHODS: A total of 193 RA patients with complete baseline and follow-up data were included in the analysis. Patients were categorized based on the subsequent therapy they received: TNFi, Abatacept, IL6 inhibition, or JAKi. Linear and logistic regression models were constructed, with changes in Disease Activity Score 28 (DAS28) between baseline and first follow-up, DAS28 remission (DAS28 < 2.6), and DAS28 low disease activity (LDA, DAS28 ≤ 3.2) as dependent variables. Various demographic and clinical variables were incorporated into the models, and backward elimination was performed to identify statistically significant predictors.

RESULTS: The results showed that 33%(63/193) of patients initiated TNFi therapy, 11%(20/193) received Abatacept, 18%(34/193) underwent IL6 inhibition, and 39%(76/193) were prescribed another JAKi therapy. Remission and LDA were achieved in 42%(81/193) and 63%(122/193) of patients, respectively. The analysis revealed that baseline Health Assessment Questionnaire (HAQ) score and not receiving abatacept were common predictors for achieving remission and LDA. Factors positively associated with a greater change in DAS28 included baseline Patient Global Assessment (PGA)(Relative Risk(RR)0.02(0.01,0.03)), tender joint count (TJC)(RR(0.06(0.01,0.12)), swollen joint count (SJC) (RR0.10(0.03,0.16)), and C-reactive protein (CRP) (RR0.02(0.01,0.03)). Conversely, baseline HAQ score (RR-0.60(-0.88,-0.31)) and not receiving abatacept (RR-0.70(-1.25,-0.15)) were negatively correlated with DAS28 change in the adjusted multivariate linear regression model.

CONCLUSIONS: Results indicated that, after adjustment, patients with poorer functionality and those receiving abatacept compared to other b/tsDMARDs exhibited less favorable short-term clinical outcomes. Further investigation is necessary due to the relatively small sample size.