Background Glucocorticoid sparing in rheumatoid arthritis (RA) treatment is crucial to minimizing adverse effects associated with long-term use. Janus kinase inhibitors (JAKi) could potentially offer a more potent glucocorticoid-sparing effect than biologic DMARDs (bDMARDs) Material and methods This is a single-centre retrospective analysis of RA patients treated with JAKi or bDMARDs. Glucocorticoid tapering, rescue therapy and discontinuation were analysed through mixed-effects models, Poisson regression and multivariable logistic regression, respectively, adjusting for baseline disease activity, demographic factors and treatment line. Results A total of 716 RA patients treated with JAKi (n = 156) or bDMARDs (n = 560) were evaluated. JAKi treatment was associated with a more rapid reduction in glucocorticoid dose within the first 6 months and 60% higher odds of discontinuation compared with bDMARDs (adjusted odds ratio 1.63; 95% CI: 1.02, 2.60, P = 0.039). Despite a higher baseline glucocorticoid dose, over 50% of JAKi-treated patients discontinued glucocorticoids after 12 months, vs ∼40% for bDMARDs. The need for glucocorticoid rescue therapy was significantly higher in the bDMARD group (rate ratio 2.66; 95% CI: 1.88, 3.74). Conclusion Our findings indicate that JAKi facilitate more rapid glucocorticoid tapering compared with bDMARDs in RA patients. These results underscore the potential of JAKi to reduce long-term glucocorticoid exposure, highlighting their value in RA management strategies, including minimizing glucocorticoid-related adverse effects.

中文翻译：

---

Janus 激酶抑制剂与生物疾病缓解抗风湿药相比在类风湿性关节炎中的糖皮质激素保留作用，单中心回顾性分析


背景类风湿性关节炎 （RA） 治疗中的糖皮质激素保留对于最大限度地减少与长期使用相关的不良反应至关重要。Janus 激酶抑制剂 （JAKi） 可能提供比生物 DMARD （bDMARDs） 更有效的糖皮质激素节省作用 材料和方法 这是对接受 JAKi 或 bDMARD 治疗的 RA 患者的单中心回顾性分析。通过混合效应模型、泊松回归和多变量 logistic 回归分别分析糖皮质激素逐渐减量、挽救治疗和停药，并调整基线疾病活动、人口学因素和治疗线。结果 共评估了 716 例接受 JAKi （n = 156） 或 bDMARD （n = 560） 治疗的 RA 患者。与 bDMARD 相比，JAKi 治疗与前 6 个月内糖皮质激素剂量的更快减少和停药几率高 60% 相关（校正比值比 1.63;95% CI： 1.02,2.60，P = 0.039）。尽管基线糖皮质激素剂量较高，但超过 50% 的 JAKi 治疗患者在 12 个月后停用了糖皮质激素，而 bDMARD 的这一比例约为 40%。bDMARD 组对糖皮质激素挽救治疗的需求显著更高 （率比 2.66;95% CI： 1.88， 3.74）。结论 我们的研究结果表明，与 bDMARDs 相比，JAKi 有助于 RA 患者更快速地减少糖皮质激素的剂量。这些结果强调了 JAKi 减少长期糖皮质激素暴露的潜力，突出了它们在 RA 管理策略中的价值，包括最大限度地减少糖皮质激素相关的不良反应。