Effectiveness, survival and prescription patterns of Janus kinase inhibitors in rheumatoid arthritis: results of a 5.9-year follow-up from the Italian Study Group of Early Arthritis (GISEA) registry

Objectives: Janus kinase inhibitors (JAKis) have emerged as a valuable treatment option for rheumatoid arthritis (RA). Still, real-world data on their retention and prescription patterns are crucial, especially considering guideline updates. This study aimed to evaluate these aspects in a large Italian RA cohort. Methods: Patients with a diagnosis of RA enrolled in the Italian Study Group on Early Arthritis (GISEA) registry initiating JAKi therapy were included. Demographic and clinical characteristics, disease activity scores and treatment survival were assessed at baseline, at 6, 12, and 24 months and at last available visit or at drug discontinuation. Log-Rank tests and Cox regression analysis were employed to assess drugs survival and factors associated with discontinuation. Prescription patterns and patients selection were analysed across three periods reflecting key events in JAKi utilisation. Results: 1303 patients were included. JAKi retention rates at 6, 12, and 24 months were 80.9%, 74.9%, and 61.1%, respectively. Glucocorticoid use, higher disease activity, and significant pain at baseline were associated with shorter retention. Conversely, first-line JAKi therapy after csDMARD failure was associated with longer retention. Prescription patterns shifted over time, with a trend towards earlier JAKi use among younger patients with established disease, and a more cautious approach following safety warnings, including reduced first-line use and less combination therapy. Conclusions: This large real-world study confirms the effectiveness of JAKis in RA, with valuable insights into factors influencing treatment survival and evolving prescription trends.