Objectives Janus kinase inhibitors (JAKinibs) are increasingly used in rheumatic diseases, yet comparative real-world data on retention, safety, and prescribing patterns remain limited. We evaluated drug survival, adverse events, and discontinuation for three JAKinibs. Methods This retrospective, three-arm comparative cohort included patients with rheumatic diseases who received ≥ 1 JAKinib between May 2020 and July 2025. Results We included 185 patients(median age 44 years, 67.0% female) with seropositive RA (n = 87), seronegative RA (n = 36), ankylosing spondylitis (n = 39), psoriatic arthritis(n = 17), and others(n = 6). Tofacitinib was prescribed in 94 patients(50.8%), baricitinib in 45 (24.3%), and upadacitinib in 69 (37.3%). Most (89.7%) received one JAKinib. Tofacitinib, baricitinib, and upadacitinib were initiated as first JAKinib in 95.7%, 86.7%, and 81.2% of cases, respectively(p = 0.012). At last follow-up, 58.9% remained on any JAKinib. Six-month survival was 81.9% for tofacitinib, 77.8% for baricitinib, and 69.6% for upadacitinib(p = 0.049); median survival was 16.5, 17, and 11 months, respectively (p < 0.001). Secondary non-response was the leading cause of discontinuation, with adverse events accounting for less than 10%. Conclusion JAKinibs showed favourable retention and safety. Treatment sequencing and early access influenced persistence; tofacitinib predominated due to early availability and prior use in biologic-naive patients, while upadacitinib was mainly prescribed after advanced therapy failure yet remained effective in refractory cases.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry align="left" nameend="c2" namest="c1"> Key Points • JAKinibs remain effective and tolerable across a range of inflammatory rheumatic diseases,regardless of prior biologic exposure or treatment line. • Upadacitinib, although often prescribed after failure of multiple advanced therapies andother JAKinibs, showed high continuation and retention rates, highlighting its role as a viablelate-line option. • Secondary unresponsiveness is the primary barrier to long-term JAKinib persistence,suggesting a need for early recognition and individualized treatment. </entry> </row> </tbody> </tgroup> </Table>

Real-world evidence on JAK inhibitors in rheumatology practice: comparative safety, efficacy, and outcomes between JAK inhibitors

期刊论文
发表日期：

2026年6月23日

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Rabia Deniz,
Ayşenur Yılmaz,
Ayşe Elif Boncukcuoğlu,
Erdem Bektaş,
Rumeysa Mirza Altıntaş,
Hazal Ceylan Tan,
Kübra Uğur,
Gül Güzelant Özköse,
Kübra Kalkan,
Cemal Bes

摘要

Objectives

Janus kinase inhibitors (JAKinibs) are increasingly used in rheumatic diseases, yet comparative real-world data on retention, safety, and prescribing patterns remain limited. We evaluated drug survival, adverse events, and discontinuation for three JAKinibs.

Methods

This retrospective, three-arm comparative cohort included patients with rheumatic diseases who received ≥ 1 JAKinib between May 2020 and July 2025.

Results

We included 185 patients(median age 44 years, 67.0% female) with seropositive RA (n = 87), seronegative RA (n = 36), ankylosing spondylitis (n = 39), psoriatic arthritis(n = 17), and others(n = 6). Tofacitinib was prescribed in 94 patients(50.8%), baricitinib in 45 (24.3%), and upadacitinib in 69 (37.3%). Most (89.7%) received one JAKinib. Tofacitinib, baricitinib, and upadacitinib were initiated as first JAKinib in 95.7%, 86.7%, and 81.2% of cases, respectively(p = 0.012). At last follow-up, 58.9% remained on any JAKinib. Six-month survival was 81.9% for tofacitinib, 77.8% for baricitinib, and 69.6% for upadacitinib(p = 0.049); median survival was 16.5, 17, and 11 months, respectively (p < 0.001). Secondary non-response was the leading cause of discontinuation, with adverse events accounting for less than 10%.

Conclusion

JAKinibs showed favourable retention and safety. Treatment sequencing and early access influenced persistence; tofacitinib predominated due to early availability and prior use in biologic-naive patients, while upadacitinib was mainly prescribed after advanced therapy failure yet remained effective in refractory cases.

Key Points

• JAKinibs remain effective and tolerable across a range of inflammatory rheumatic diseases,regardless of prior biologic exposure or treatment line.

• Upadacitinib, although often prescribed after failure of multiple advanced therapies andother JAKinibs, showed high continuation and retention rates, highlighting its role as a viablelate-line option.

• Secondary unresponsiveness is the primary barrier to long-term JAKinib persistence,suggesting a need for early recognition and individualized treatment.