A NEW study from the FIRST registry has found that cycling between different Janus kinase inhibitors (JAKis) may be more effective than switching to biological DMARDs (bDMARDs) for patients with rheumatoid arthritis (RA) who do not respond adequately to their initial JAKi therapy.
Researchers analysed 434 RA patients who began JAKi treatment, identifying 138 (31.8%) as having an inadequate response (JAKi-IR), meaning they either switched medications due to lack of improvement or failed to reach low disease activity within 26 weeks. The study compared 45 patients who switched to bDMARDs and 31 patients who cycled to another JAKi, tracking their response at 26 weeks.
Patients who cycled to another JAKi showed greater improvements in Clinical Disease Activity Index (CDAI) scores and higher remission rates than those who switched to bDMARDs. Importantly, there were no significant differences in treatment retention or adverse events between the two groups. The study also identified three response patterns, with the best treatment outcomes observed in those who cycled to another JAKi.
These findings suggest that patients with JAKi-IR may benefit more from trying a different JAKi rather than switching to a bDMARD, reinforcing the need for personalised treatment strategies in RA management.
Aleksandra Zurowska, EMJ
Reference
Miyazaki Y et al. Switching to biological DMARDs versus cycling among JAK inhibitors in patients with rheumatoid arthritis and with inadequate response to JAK inhibitors: from FIRST registry. RMD Open. 2025;11:e004987.
