P008 High response rate to Janus Kinase inhibitors after multiple biologic drug failures, across disease indications, in a District General Hospital: results from an audit of the prescribing, safety and efficacy of Janus Kinase inhibitor
Authors: Escudero Alexa , Jain Sugandh , Nisoe Nwe , McNally Jeremy , Wardak Habib 
Published: April 2024

Abstract

Background/Aims
This audit aimed to improve the standard of prescribing JAK inhibitors and to determine the sustainability of response in Rheumatology patients at Royal Berkshire hospital (RBH) in Reading. During the last decade Janus kinase (JAK) inhibitors have had a dramatic uptake across multiple conditions in Rheumatology to control inflammation, reduce damage, pain and fatigue. Emerging data provides insight into their safety and effectiveness. These medications are contraindicated in patients with serious infections, cancer, blood clots, pregnancy and abnormal liver or renal function. Prescribing these medications needs careful consideration. We want to ensure we are taking appropriate precautions to minimize them and to review their efficacy in a real world District General Hospital setting.

Methods
Data was collected retrospectively from 100 patients who started treatment with JAK inhibitors in the last five years. We reviewed the indication, stage of disease, risk factors, whether patient information was provided and the response to treatment. We included patients with Rheumatoid arthritis (RA), Ankylosing Spondylitis, Psoriatic Arthritis. Our data collection template covered demographic information, medical history and disease activity at baseline as well as after starting JAK inhibitors; concomitant use of other DMARDs, safety and efficacy.

Results
A cohort of 100 patients (69 female and 31 male, average age 51.4 years) diagnosed with rheumatic conditions. The largest group were started on Baricitinib 64%, the smallest group on Upadacitinib. Baricitinib was the first JAK inhibitor approved for use in Rheumatology. Most RA patients were seropositive and had active disease at baseline. Comorbidities such as hypertension and diabetes were noted in 24 % and 14% of the patients respectively. 31% had a past history of smoking history, 9% had a history of malignancy. 22% of patients were on JAK monotherapy, the majority required an additional disease modifying antirheumatic drug (DMARDs). 43% of patients had tried two to three different biologics before starting JAK inhibitors. The average time from diagnosis to the first use of JAK inhibitors was 11 years. 2% of patients developed MACE and 3% herpes zoster on JAK. Only one of the deceased patients was on JAK inhibitors at the time of death and no causality was found. In &lt; 10% of patients discussion on potential side effects was documented at baseline. 36% have discontinued the medication.

Conclusion
JAK inhibitors are highly effective in a real world population even when started after two to three biologic failures. A significant reduction in disease activity and sustainable remission was obtained in 64% of our patients. 43% of patients had previously failed to two or three biologics before starting a JAK inhibitor. We could improve patient education before starting treatment.

Disclosure
A. Escudero: None. S. Jain: None. N. Nisoe: None. J. McNally: None. H. Wardak: None.