Variables Associated with Choice of Janus Kinase Inhibitors (JAKs) vs Biologics for Treatment of Rheumatoid Arthritis (RA)


Singh JA1, Radtchenko J2, Soloman N3, Huston K4, Helfgott SM5, Edgerton C6
1University of Alabama at Birmingham, Birmingham, AL, USA, 2Trio Health, Louisville, CO, USA, 3Arizona Arthritis & Rheumatology Associates, Phoenix, AZ, USA, 4The Center for Rheumatic Disease & Allergy-Immunology, Kansas City, MO, USA, 5Brigham and Women's Hospital, Boston, MA, USA, 6Articularis Healthcare, Summerville, SC, USA

Presentation Documents

OBJECTIVES : We evaluated characteristics associated with utilization of biologics vs JAKs in RA patients.

METHODS : EMR from the American Rheumatology Network (ARN) - Trio Health Rheumatology registry were used. The ARN is a physician led and owned organization with 200+ rheumatologists across the US. RA patients initiating a new regimen following baricitinib approval were selected. Differences between groups were assessed using t-test for continuous variables and chi-square test for categorical. Logistic regression (LR) was used to assess characteristics associated with prescribing JAKs vs biologics.

RESULTS : Of 22,929 adults who initiated or switched to new biologics/JAKs in the study period, 2,943 (13%) received JAKs; of them, 2,253 (77%) were on tofacitinib, 203 (7%) on baricitinib, and 487 (17%) on upadacitinib. Compared to patients on biologics, JAK group had significantly (p<.001) higher proportion of patients with commercial insurance (57% vs 49%), lower proportion of patients on methotrexate (27% vs 36%) and glucocorticoids (44% vs 50%), patients with baseline remission/low disease activity [DAS] (50% vs 55%). JAK patients were younger (mean age 57.8 vs 58.6), had shorter follow-up (mean 12 vs. 13.6 mo), duration of therapy (mean 7.9 vs 8.9 mo), and higher # of prior regimens (mean 2.9 vs 2.3). The difference between DAS at 6 mo since switch was not significant (61% vs 63%, p=0.152). Based on LR, patients with moderate/high DAS (adjusted odds ratio (OR)=1.2 CI 1.1-1.4 vs low DAS/remission), middle age (41-64 yrs vs 18-40 OR=1.3 CI 1.1-1.7) and those with higher # of prior regimens (OR=1.1 CI 1.07-1.13) were more likely to receive JAKs, while patients with non-commercial payer types (Medicare/Medicaid vs commercial OR=0.7 CI 0.6-0.8, other payer vs commercial OR=0.5 CI 0.4-0.7) were less likely to receive JAKs.

CONCLUSIONS : JAKs were used in heavily pre-treated patients with worse baseline DAS. Future research will assess reasons for switch documented in physician notes.

Conference/Value in Health Info

2021-05, ISPOR 2021, Montreal, Canada

Value in Health, Volume 24, Issue 5, S1 (May 2021)




Clinical Outcomes, Real World Data & Information Systems

Topic Subcategory

Clinical Outcomes Assessment, Clinician Reported Outcomes, Distributed Data & Research Networks


Musculoskeletal Disorders

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