Janus kinase inhibitors show a longer drug survival than biologics in a real-world cohort of patients with rheumatoid arthritis - a retrospective analysis from the RHADAR database

Numerous biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) have been approved for treating rheumatoid arthritis (RA), including Janus kinase inhibitors (JAKi), rituximab, abatacept, interleukin-6 inhibitors (IL-6i) and tumor necrosis factor inhibitors (TNFi). Real-world data regarding treatment persistence and drug survival in the time period following the approval of JAKI are limited. To investigate the persistence and drug survival of different (b/tsDMARDs) in patients with RA based on real-world data from German outpatients. We performed a retrospective analysis of RA patients in the German RHADAR database who received a newly prescribed therapy with a b/tsDMARD between January 15, 2015 and October 17, 2023. To compare drug survival, we used Cox regression analyses adjusted for age, sex and disease duration. We included 4678 patients (79.9% female, mean age 58.7 years, mean disease duration 11.7 years). TNFi (47.8%) and JAKi (29.4%) were most frequently prescribed. The five-year drug survival rate was highest for JAKi (68.3%), followed by TNFi (58.6%), IL-6i (58.6%), abatacept (55.0%), and rituximab (53.3%). Compared to JAKi, Cox regression showed a higher discontinuation risk for rituximab (HR 1.36, p = 0.015), abatacept (HR 1.46, p < 0.001), IL-6i (HR 1.20, p = 0.026), and TNFi (HR 1.29, p < 0.001). Rituximab had the highest two-year survival (70.3%) but a sharp decline afterward, with 60% of discontinuations occurring between March 2020 and July 2022. In a real-world setting in German outpatients with RA, JAKi was associated with longer drug survival than bDMARDS. There were no significant differences in treatment persistence among different bDMARDs.