Mortality and medical utilization in rheumatoid arthritis associated interstitial lung disease: A real-world, large-scale retrospective study comparing Janus kinase inhibitors and tumor necrosis factor inhibitors

Abstract

Objective

The study is aimed to investigate the effectiveness of Janus kinase inhibitors (JAKi) on rheumatoid arthritis associated interstitial lung disease (RA-ILD) compared to tumor necrosis inhibitors (TNFi).

Methods

We applied a retrospective matched cohort analysis using the TriNetX database. The study included patients diagnosed with RA-ILD who received new prescriptions for JAKi or TNFi. The primary outcome was all-cause mortality, and secondary outcomes included medical utilizations. Hazard ratios (HRs) and Cox regression analyses were performed to assess these outcomes.

Results

Among 23,707 RA-ILD patients, 812 were selected for each treatment group (JAKi and TNFi) following propensity score matching. The JAKi group exhibited a higher all-cause mortality risk compared to the TNFi group (HR 1·458, 95 % CI: 1·136–1·870). JAKi group was also associated with a higher risk for hospitalization (HR 1·167, 95 % CI: 1·011–1·348), critical care services (HR 1·854, 95 % CI: 1·414–2·431), and mechanical ventilation (HR 2·609, 95 % CI: 1·718–3·962). Subgroup analysis indicated a heightened mortality risk in JAKi-treated patients aged over 65 years old (HR 1·815, 95 % CI: 1·316–2·503), and those with cardiovascular risk factors (HR 1·636, 95 % CI: 1·197–2·237). Sensitivity analysis yielded results that were not entirely consistent with the primary analysis, except for the subgroup aged over 65, where results remained aligned.

Conclusion

This real-world, large-scale cohort study indicated an association of higher mortality and medical utilizations in RA-ILD patients treated with JAKi compared to TNFi, especially among those over 65 years of age. These findings highlight the need for careful assessment when prescribing JAKi or TNFi for patients with RA-ILD.