Real-world experience with Janus kinase inhibitors in rheumatoid and psoriatic arthritis: retention and discontinuation factors in a UK six-centre cohort
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objectives To investigate real-world use of Janus kinase inhibitors (JAKis) prescribed for RA and PsA. Methods We conducted a retrospective review of all patients treated with baricitinib, filgotinib, tofacitinib and upadacitinib across six UK rheumatology centres from time of first use in routine care until November 2024. Standardised data were collected and retention was calculated using Kaplan–Meier analysis. Factors associated with JAKi discontinuation were analysed using multivariable Cox regression analyses. Results A total of 985 patients [79.5% female, mean age 60 years, RA 849 (86.2%), PsA 136 (13.8%)] were reviewed. MTX and glucocorticoids (GCs) were co-prescribed in 43% and 33.6% of cases, respectively. Among GC users, dose reduction occurred in 18% and complete discontinuation in 61.8%. JAKis were prescribed as a first-line biologic DMARD in 7.5% and as a third-line or later in 78.8%. Median retention was 49 months (range 1–85; 95% CI 42.62, 55.37), with 52.8% remaining on treatment at censure, with no difference between RA and PsA populations. Retention on tofacitinib was significantly lower than baricitinib (P < 0.001) and upadacitinib (P = 0.007). Variables significantly associated with higher JAKi discontinuation risk were female sex [hazard ratio (HR) 1.66 (95% CI 1.28, 2.16)], increasing age [HR 1.01 (95% CI 1.00, 1.02)] and tofacitinib (vs baricitinib) treatment [HR 2.27 (95% CI 1.64, 3.14)]. Among RA patients, MTX co-prescription was associated with a lower discontinuation risk [HR 0.81 (95% CI 0.66, 0.98)]. Conclusion In a real-world setting, JAKi demonstrated high retention in RA and PsA, with a GC-sparing effect. Retention is lower for female sex, older age, tofacitinib vs baricitinib and use without MTX in RA, whereas place in the treatment pathway did not impact retention outcomes.
DOI: 10.1093/rap/rkag024
Authors: Joseph Nathan, Bayram Farisogullari, Nicholas Jones, Mohammad Ayoub, James Brown, Sarah Levy, James Brader, Ayse Ersoy, Blossom Israni, Mark Lloyd, Afzal Latheef, Diane Hill, Amybel Taylor, Darshani Arachchige, Hlaing Chitsu, Helen Linklater, Kunal Lather, Luke Gompels, Eman Elfar, Ritu Malaiya, Pedro M Machado, Patrick D W Kiely
Institutions: St George’s University Hospitals NHS Foundation Trust, University College London, Croydon University Hospital, Frimley Health NHS Foundation Trust, Surrey and Sussex Healthcare NHS Trust, Taunton & Somerset NHS Foundation Trust, Somerset NHS Foundation Trust, Epsom and St Helier University Hospitals NHS Trust, University College London Hospitals NHS Foundation Trust, London North West Healthcare NHS Trust, Northwick Park Hospital, National Institute for Health and Care Research, UCL Biomedical Research Centre, City St George's, University of London
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,974
OpenAlex ID: W7130356768