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TOPLINE:

Patients with rheumatoid arthritis (RA) and preserved kidney function who started reduced doses of JAK inhibitors had treatment persistence and disease control that were similar to those in patients who started standard doses over 24 months of follow‑up.

METHODOLOGY:

• Researchers conducted an observational cohort study to compare 24‑month treatment persistence between standard‑dose and reduced‑dose JAK inhibitors in patients with RA, with a primary focus on those with preserved renal function.
• They included 1135 patients from a registry (ANSWER) who started treatment with JAK inhibitors at multiple Japanese centers between March 2013 and October 2025. Mean ages ranged from 63.8 to 65.6 years, and 83.6%-85.3% of the patients were women.
• Patients were classified according to whether they were started on a label-recommended standard dose (n = 891) or a physician-selected reduced dose (n = 244). Renal function was considered reduced if the estimated glomerular filtration rate was < 60 mL/min/1.73 m², and propensity‑score matching was applied in the cohort with preserved renal function.
• Based on the number of poor prognostic factors present, patients were stratified into low-burden (two or less factors) and high-burden groups (three to four factors); the factors included seropositivity, disease activity, C-reactive protein levels, and functional impairment.
• The primary endpoint was 24‑month all‑cause drug retention, defined as the time from the initiation of a JAK inhibitor to permanent discontinuation.

TAKEAWAY:

• In the propensity score-matched cohort of patients with preserved renal function, 24-month drug retention did not differ significantly between patients started on reduced doses of JAK inhibitors and those started on standard doses.
• Disease activity improved similarly over 24 months in both dosing groups, and glucocorticoid use remained low without compensatory increases in the reduced-dose group.
• Patients with two or less poor prognostic factors showed comparable retention between doses. However, patients with three to four such factors who were receiving a standard dose had a lower risk for discontinuation due to ineffectiveness (hazard ratio [HR], 0.43; 95% CI, 0.19-0.96) and a modestly lower risk for discontinuation due to adverse events (HR, 0.83; 95% CI, 0.60-0.99) than did those receiving a reduced dose.
• In supportive unmatched analyses of patients with reduced renal function, standard dosing was associated with higher 24-month retention than reduced or label-adjusted renal dosing.

IN PRACTICE:

“In patients with preserved renal function, reduced-dose JAKi [JAK inhibitor] initiation was associated with 24-month treatment persistence comparable with standard dosing,” the authors wrote.

SOURCE:

The study was led by Yuji Nozaki, Kindai University School of Medicine, Sakai, Japan. It was published online on April 27, 2026, in Annals of the Rheumatic Diseases.

LIMITATIONS:

Propensity score matching adjusted only for measured variables and could not account for unmeasured factors. Researchers analyzed only the initial dose and did not model later dose changes over time. The study was conducted only in Japan, limiting generalizability.

DISCLOSURES:

The study used data from the ANSWER cohort and received support from grants provided by 12 pharmaceutical companies, including AbbVie GK, Chugai, and Eli Lilly, along with an information technology service company (CAC). Several authors reported receiving speaker fees, research grants, consulting fees, and payments for lectures from industry partners, including the funding companies. Some authors reported receiving departmental or institutional support from industry and affiliations with industry-funded units.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.