Add-on effectiveness of methotrexate or iguratimod in patients with rheumatoid arthritis exhibiting an inadequate response to Janus kinase inhibitors: The ANSWER cohort study

• Published in: Modern rheumatology 2023-07, Vol.33 (4), p.690-699
• Main Authors: Ebina, Kosuke, Hirano, Toru, Maeda, Yuichi, Okita, Yasutaka, Etani, Yuki, Hirao, Makoto, Yamamoto, Wataru, Hashimoto, Motomu, Murata, Koichi, Onishi, Akira, Jinno, Sadao, Hara, Ryota, Son, Yonsu, Amuro, Hideki, Kotani, Takuya, Shiba, Hideyuki, Katayama, Masaki, Yamamoto, Keiichi, Kumanogoh, Atsushi, Okada, Seiji, Nakata, Ken
• Format: Article
• Language: English
• Subjects: Antirheumatic Agents - adverse effects; Arthritis, Rheumatoid - drug therapy; Cohort Studies; Drug Therapy, Combination; Humans; Janus Kinase Inhibitors - therapeutic use; Methotrexate; Middle Aged; Retrospective Studies; Treatment Outcome
• ISSN: 1439-7595; 1439-7609
• DOI: 10.1093/mr/roac092

ABSTRACT Objectives This multicenter, retrospective study evaluated the effectiveness of add-on methotrexate (MTX) or iguratimod (IGU) in patients with rheumatoid arthritis exhibiting an inadequate response to Janus kinase inhibitors (JAKis). Methods Forty-five patients were treated with new additional MTX (n = 22) or IGU (n = 23) and followed for 6 months. Patients’ background is as follows: age, 59.2 years; disease activity score of 28 joints with C-reactive protein (DAS28-CRP), 3.4; clinical disease activity index, 15.7; biological disease-modifying antirheumatic drug (DMARD)-switched cases, 77.8%; first JAKi cases, 95.6%; and JAKi treatment: tofacitinib (n = 25), baricitinib (n = 17), upadacitinib (n = 2), and peficitinib (n = 1) for 9.6 months. Results Thirty-five patients continued the combination therapy for 6 months without a significant change in concomitant glucocorticoid or other conventional synthetic DMARDs. DAS28-CRP (MTX, 3.6 to 2.6, p