Effectiveness and safety of anti-CD20 monoclonal antibodies versus csDMARDs in anti-Jo-1 antisynthetase syndrome: A retrospective cohort study

Objectives

Anti-Jo-1 antisynthetase syndrome (Jo1⁺ASyS) is the most common form of idiopathic inflammatory myopathy with high relapse rates and limited treatment options beyond csDMARDs, which frequently fail to achieve adequate disease control. This study aimed to evaluate the efficacy and safety of anti-CD20 monoclonal antibodies (CD20mAbs) compared to conventional synthetic(cs) DMARDs in patients with Jo1⁺ASyS.

Methods

A single-center retrospective cohort of patients with Jo1⁺ASyS were collected at RenJi Hospital in China (2007–2023). A prevalent new-user design with time-based propensity scores, applied without replacement, was used to match CD20mAb and csDMARD users. The primary outcome was the percentage of patients reaching Low Disease Activity (5-item LDA), as defined by the absence of active arthritis, myositis, ILD, fever, and prednisone dosage ≤7.5 mg/day.

Results

A total of 166 eligible treatment regimens, including CD20mAbs and csDMARDs, were extracted from 128 Jo1⁺ASyS patients with a median follow-up period of 5 years. Utilizing propensity score, 49 pairs of individual prescriptions for CD20mAbs and csDMARDs users were matched. The group treated with CD20mAbs exhibited a significantly higher rate of achieving LDA compared to those treated with csDMARDs (46.9 % vs. 22.4 %, p = 0.011). No significant differences in exposure-adjusted incidence rate were detected between the two treatment modalities (CD20mAbs vs. csDMARDs = 7.911 vs. 6.479 per 100 patient-yr, RR = 1.22; 95 % CI: 0.64, 2.36), with respect to major infections. Sensitivity analyses further confirmed the robustness of the superior effectiveness of the CD20mAbs compared to the csDMARDs.

Conclusion

CD20mAbs exhibited remarkable treatment efficacy and acceptable safety in patients with Jo1⁺ASyS. Cumulative evidence, including ours suggested that CD20mAbs should be considered as a first-line option for Jo1⁺ASyS.