Affiliation:
1. Merative, Cambridge Massachusetts
2. University of Texas at San Antonio
3. Corporal Michael J. Crescenz VA Medical Center and Perelman School of Medicine University of Pennsylvania Philadelphia
Abstract
ObjectiveThe study was to determine the prevalence of baseline risk factors for cardiovascular outcomes and cancer among commercially‐insured patients with rheumatoid arthritis (RA) during their first dispensed treatment for either tumor necrosis factor inhibitors (TNFi) or JAK inhibitors (JAKi).MethodsPatients with RA from August 16, 2019 to March 31, 2022 were identified in the Merative MarketScan Commercial and Medicare databases. The first date that a TNFi or JAKi was dispensed was the index date, and baseline risk factors were assessed among patients continuously eligible for 12 months before the index date. Patients who had the following were stratified into an elevated risk category: age ≥65 years, smoking, or a history of a major adverse cardiovascular event, venous thromboembolism, or cancer. The prevalence of modifiable risk factors was also reported: hypertension, hyperlipidemia, obesity, and diabetes. The crude prevalence and prevalence difference (PD) were reported.ResultsA total of 12,673 patients (TNFi [n = 7,748; 61%] and JAKi [n = 4,925; 39%]) met inclusion criteria. The prevalence of elevated risk was the same for all patients using TNFi (n = 2,051; 26%) and JAKi (n = 1,262; 26%). Compared with patients having low risk, patients with an elevated risk also had a higher prevalence of at least one primary modifiable risk factor for both patients using JAKi (79% vs 58%; PD 21%, 95% confidence interval [CI] 18%–24%) and TNFi (81% vs 60%; PD 21%, 95% CI 19%–23%).ConclusionIn recent years, JAKi and TNFi were used in similar proportions to treat RA among commercially‐insured patients at elevated cardiovascular and cancer risk. Because uncontrolled disease, modifiable comorbidities, and treatment with JAKi are associated with these adverse events, future studies evaluating how practice patterns may be affected by the emergence of safety data will be of value.
Reference16 articles.
1. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis
2. Janus Kinase (JAK) inhibitors: drug safety communication–FDA requires warnings about increased risk of serious heart‐related events cancer blood clots and death.US Food and Drug Administration website. Updated September 1 2021. Accessed November 15 2023.https://www.fda.gov/safety/medical‐product‐safety‐information/janus‐kinase‐jak‐inhibitors‐drug‐safety‐communication‐fda‐requires‐warnings‐about‐increased‐risk
3. Waiting for JAK inhibitor safety data
4. Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a consensus statement
5. Tofacitinib and Risk of Malignancy: Results From the Safety of Tofacitinib in Routine Care Patients With Rheumatoid Arthritis (STAR‐RA) Study