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 biological Disease-Modifying Antirheumatic Drugs (bDMARDs) Material and methods This is a single-center retrospective analysis of RA patients treated with JAKi or bDMARDs. Glucocorticoid tapering, rescue therapy and discontinuation were analyzed 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 JAK inhibitors facilitate more rapid glucocorticoid tapering compared with bDMARDs in RA patients. These results underscore the potential of JAK inhibitors to reduce long-term glucocorticoid exposure, highlighting their value in RA management strategies, including minimizing glucocorticoid-related adverse effects.

中文翻译：

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Janus激酶抑制剂与生物疾病修饰抗风湿药物相比对类风湿性关节炎的糖皮质激素节约作用，单中心回顾性分析


背景 类风湿关节炎（RA）治疗中糖皮质激素的节约对于最大限度地减少长期使用相关的副作用至关重要。 Janus 激酶抑制剂 (JAKi) 可能比生物疾病缓解抗风湿药物 (bDMARD) 提供更有效的糖皮质激素节约作用。 材料和方法 这是对使用 JAKi 或 bDMARD 治疗的 RA 患者进行的单中心回顾性分析。分别通过混合效应模型、泊松回归和多变量逻辑回归分析糖皮质激素逐渐减量、挽救治疗和停药，并根据基线疾病活动度、人口统计学因素和治疗线进行调整。结果 总共评估了 716 名接受 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更快减少相关，并且停药的几率高出 60%（调整后的比值比 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 个月后停用糖皮质激素，而 bDMARD 治疗的患者为 40%。 bDMARD 组对糖皮质激素挽救治疗的需求显着更高（比率比 2.66（95% CI，1.88-3.74））。结论 我们的研究结果表明，与 bDMARD 相比，JAK 抑制剂有助于 RA 患者更快速地减量糖皮质激素。这些结果强调了 JAK 抑制剂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。