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Master Thesis

Maintien thérapeutique des inhibiteurs de JAK et des bDMARDs dans la polyarthrite rhumatoïde

Abstract : Objectives: the continuation rate of a drug is an indirect measure of effectiveness and tolerance. The aim of this study was to assess the therapeutic maintenance in real-life of biologic drug modifying rheumatic diseases (bDMARDs) and JAK inhibitors (JAKi) in rheumatoid arthritis (RA) over an 18-month period and to analyze factors predictive of treatment continuation as well as reasons for discontinuation. Methods: This is a retrospective analysis of the medical records of RA patients followed at Bordeaux University Hospital who received a new prescription for a JAKi or a bDMARD between November 1, 2017 and October 10, 2018. Clinical and biological data were collected at baseline and up to a 18-month follow-up. Survival curves were constructed using the Kaplan-Meier method and comparison made by logrank testing. Factors associated with maintenance at 12 and 18 months were assessed by univariate and multivariate analyses. Results: among the 129 patients included, 47 were prescribed a JAKi, 43 a TNF inhibitor (TNFi) and 39 another bDMARD (abatacept, rituximab, anti IL6). At 18 months, the global therapeutic maintenance rate was 39% (45% for JAKi, 37% for TNFi and 33% for other bDMARDs). There was no significant difference in the crude overall drug retention between treatments (p = 0,26). Presence of corticosteroids at initiation was the only predictive factor associated with maintenance in both univariate and multivariate analysis by showing a higher discontinuation at 18 months (p = 0.05). However concomitant csDMARDs therapy showed no association with continuation (p = 0,87). The main causes of discontinuation were global lack of efficacy at 51% and occurrence of adverse events (AE) at 38%. Conclusion: This observational study has shown a similar drug retention between JAKi and other bDMARDs.
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Submitted on : Monday, October 4, 2021 - 10:06:39 AM
Last modification on : Wednesday, November 3, 2021 - 5:23:47 AM
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Camille Bie. Maintien thérapeutique des inhibiteurs de JAK et des bDMARDs dans la polyarthrite rhumatoïde. Sciences du Vivant [q-bio]. 2020. ⟨dumas-03363643⟩

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