Why carry out this study?

In the real-world management of biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) for rheumatoid arthritis (RA), bDMARDs are frequently preferred as first-line therapy due to safety concerns of Janus kinase inhibitor (JAKi).

Although JAKi are more commonly considered for the second-line therapy, the efficacy and safety of both bDMARDs and JAKi in patients with RA unresponsive to first-line b/tsDMARDs remain unclear.

Second-line therapy is an essential phase in preventing progression to difficult-to-treat rheumatoid arthritis (D2TRA), and we compared the efficacy and safety of second-line b/tsDMARDs from our registry.

What was learned from the study?

In RA patients unresponsive to first-line b/tsDMARDs, JAKi as second-line therapy resulted in the most rapid reduction in Clinical Disease Activity Index (CDAI) at 4 weeks after initiation of b/tsDMARDs and achieved the highest CDAI remission rate at 24 weeks. Among the three types of JAKi (tofacitinib, baricitinib, upadacitinib), upadacitinib (UPA) was most effective in achieving CDAI remission in RA patients unresponsive to first-line b/tsDMARDs.

Selecting JAKi, especially UPA, may effectively improve the disease activity for RA patients unresponsive to first-line b/tsDMARDs. Further large-scale studies are needed to clarify the efficacy and safety of UPA.