#3-03E. Optimizing Treatment for Elderly-Onset RA: Biologics vs. JAK Inhibitors (Rheumatology, 2025)

Navigating treatment choices for elderly-onset rheumatoid arthritis (EORA) remains a significant clinical challenge due to the scarcity of randomized controlled trials involving this specific demographic. This episode examines a multicenter retrospective study utilizing the Japanese ANSWER cohort to compare drug retention rates among TNF inhibitors, IL-6 inhibitors, CTLA4-Ig, and JAK inhibitors in patients with RA onset at age 60 or older. Using propensity score weighting to analyze 835 treatment courses, the study reveals a critical trade-off: while both IL-6 and JAK inhibitors demonstrated significantly lower discontinuation rates due to ineffectiveness compared to TNF inhibitors, JAK inhibitors were associated with a markedly higher risk of discontinuation due to adverse events. When critically appraising this evidence, listeners must consider the observational nature of the study and the lack of adjustment for specific comorbidities like diabetes or respiratory diseases, which introduces potential selection bias. For clinicians, these findings suggest that while IL-6 inhibitors may offer a favorable balance of retention and efficacy for EORA patients, the use of JAK inhibitors requires rigorous safety stratification and individualized risk-benefit assessment.

Citation: Jinno, S., Onishi, A., et al. Comparison of retention of biologics in Japanese patients with elderly-onset rheumatoid arthritis—the ANSWER cohort study. Rheumatology. 2025.

DOI: 10.1093/rheumatology/keae081

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.