Efficacy and safety of Janus kinase inhibitors in patients with difficult-to-treat rheumatoid arthritis

Objectives: This study evaluated the effectiveness of Janus kinase inhibitors (JAKi) in patients with difficult-to-treat rheumatoid arthritis (D2T RA). Methods: This study included 220 patients with RA who were treated with JAKi. Sixty-two patients were na & iuml;ve to biological disease-modifying antirheumatic drugs (bDMARDs)/JAKi (1st group), 57 patients were failure to one bDMARDs/JAKi (2nd group), and 101 patients were failure to >= 2 bDMARDs/JAKi. Of these 101 patients, 25 did not meet the D2T RA criteria (non-D2T RA group) and 76 met the D2T RA criteria (D2T RA group). Results: DAS28-ESR was improved in all groups at 24 weeks (1st: P < .01, 2nd: P < .01, non-D2T RA: P = .01, D2TRA: P = .02), and improvement ratio of DAS28-ESR was not different between DT2RA group and 2nd (P = .73) or non-D2T RA group (P = .68). Glucocorticoid use [odds ratios: 8.67; 95% confidence interval (CI): 1.23-60.90; P = .03] and number of past bDMARD/JAKi uses >= 3 (odds ratios: 10.55; 95% CI: 1.39-80.30; P = .02) were risk factors for DAS28-ESR >= 3.2 at 24 weeks in the D2T RA group. Conclusions: Clinical efficacy of JAKi in D2T RA group did not differ from that in 2nd and non-D2T RA groups. Glucocorticoid use and multiple bDMARD/JAKi failure were poor prognostic factors for D2T RA.