Real-world treatment maintenance, effectiveness, and safety of four JAK inhibitors (tofacitinib, baricitinib, upadacitinib, filgotinib) in 120 RA patients at a single French center (April 2018–November 2023), including a before-vs-after comparison of the October 2022 EMA PRAC prescribing restrictions.
Overall drug survival was 73% at 12 months, 62% at 24 months, and 57% at 36 months. All four JAKi reduced DAS28-CRP by –1.57 ± 1.26 at 6 months and –1.13 ± 1.63 at 12 months. Serious cardiovascular/thromboembolic events (3 pulmonary embolisms, 1 myocardial infarction) occurred only in high-risk patients treated before PRAC; zero such events occurred after PRAC.
- Single-center retrospective design limits generalizability. - Filgotinib had much shorter follow-up than other agents, making long-term persistence comparisons unreliable. - Adverse events were only captured when they caused discontinuation, likely underestimating the true safety burden.
Screen RA patients carefully for cardiovascular and thromboembolic risk before starting any JAK inhibitor — all serious vascular events in this cohort occurred in high-risk patients predating PRAC restrictions. After PRAC-aligned patient selection, baricitinib suits older, more comorbid patients; upadacitinib fits high-disease-burden cases; and filgotinib is a reasonable choice for younger, lower-risk women.
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