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.