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Objective <p>The objective of this study is to compare the effectiveness of TNF inhibitors (TNFi), JAK inhibitors (JAKi), and conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) in the treatment of anti-citrullinated peptide antibody-positive (ACPA +) and anti-citrullinated peptide antibody-negative (ACPA −) naïve rheumatoid arthritis (RA) patients.</p> Methods <p>In this real-world, observational, multi-center, retrospective cohort study in northwest China, we investigated patients with a diagnosis of RA from October 2023 to August 2025. A total of 563 RA patients who met the 2010 ACR/EULAR classification criteria were included and treated with a TNFi (<i>n</i> = 63), a JAKi group (<i>n</i> = 119), and csDMARDs only (<i>n</i> = 381). All evaluation indicators across treatment groups (TNFi, JAKi, and csDMARDs-only) were analyzed by two-way ANOVA with Sidak’s multiple comparison tests.</p> Results <p>RA patients receiving TNFi, JAKi, or csDMARDs-only experienced comparable clinical benefits. Both ACPA + and ACPA − patients exhibited similar responses among the three treatment groups, with no significant differences in the improvement of evaluation indicators such as HAQ-DI, VAS, PVAS, DVAS, DAS28_ESR, DAS28_CRP, SDAI, and CDAI. The csDMARDs-only group has the highest drug persistence rate at the 12th month among all groups. There are adverse events in the TNFi and JAKi groups, including one case of urinary tract infection, two cases of gastrointestinal reactions, and two cases of abnormal liver function.</p> Conclusion <p>TNFi, JAKi, and csDMARDs-only exhibit similar efficacy in treating naïve RA patients, irrespective of ACPA status. In naïve RA patients, the initial combination of TNFi or JAKi does not have better clinical benefit.</p> Trial registration <p>This trial was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR, https://www.chictr.org.cn/index.html ), a Primary Registry in the World Health Organization International Clinical Trial Registry Platform (WHO ICTRP), under the identifier ChiCTR2300068472.<Table Float="No" ID="Taba"> <tgroup cols="3"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <colspec align="left" colname="c3" colnum="3" /> <tbody> <row> <entry align="left" nameend="c3" namest="c1"> <p><b>Key Points</b></p> <p>• <i>TNFi, JAKi, and csDMARDs-only showed similar effectiveness during 12 months in naïve patients.</i></p> <p>• <i>ACPA status had no significant effect on the efficacy of TNFi, JAKi, and csDMARDs.</i></p> <p>• <i>The drug persistence of csDMARDs-only is better than that of JAKi and TNFi within 12 months.</i></p> </entry> </row> </tbody> </tgroup> </Table></p>

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Compared effectiveness of TNF inhibitors, JAK inhibitors, and csDMARDs in naïve rheumatoid arthritis patients: a real-world, observational, multi-center, retrospective cohort study in Northwest China

  • 期刊论文

  • 发表日期：

    2026年4月8日

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  • Jiawei Wang,
  • Guangzhi Xiao,
  • Aixin Huo,
  • He Jiang,
  • Rui Li,
  • Juan Li,
  • Xiaoyan Li,
  • Yuhong Liu,
  • Zhaohui Zheng,
  • Yan Zheng

摘要

Objective

The objective of this study is to compare the effectiveness of TNF inhibitors (TNFi), JAK inhibitors (JAKi), and conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) in the treatment of anti-citrullinated peptide antibody-positive (ACPA +) and anti-citrullinated peptide antibody-negative (ACPA −) naïve rheumatoid arthritis (RA) patients.

Methods

In this real-world, observational, multi-center, retrospective cohort study in northwest China, we investigated patients with a diagnosis of RA from October 2023 to August 2025. A total of 563 RA patients who met the 2010 ACR/EULAR classification criteria were included and treated with a TNFi (n = 63), a JAKi group (n = 119), and csDMARDs only (n = 381). All evaluation indicators across treatment groups (TNFi, JAKi, and csDMARDs-only) were analyzed by two-way ANOVA with Sidak’s multiple comparison tests.

Results

RA patients receiving TNFi, JAKi, or csDMARDs-only experienced comparable clinical benefits. Both ACPA + and ACPA − patients exhibited similar responses among the three treatment groups, with no significant differences in the improvement of evaluation indicators such as HAQ-DI, VAS, PVAS, DVAS, DAS28_ESR, DAS28_CRP, SDAI, and CDAI. The csDMARDs-only group has the highest drug persistence rate at the 12th month among all groups. There are adverse events in the TNFi and JAKi groups, including one case of urinary tract infection, two cases of gastrointestinal reactions, and two cases of abnormal liver function.

Conclusion

TNFi, JAKi, and csDMARDs-only exhibit similar efficacy in treating naïve RA patients, irrespective of ACPA status. In naïve RA patients, the initial combination of TNFi or JAKi does not have better clinical benefit.

Trial registration

This trial was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR, https://www.chictr.org.cn/index.html ), a Primary Registry in the World Health Organization International Clinical Trial Registry Platform (WHO ICTRP), under the identifier ChiCTR2300068472.

Key Points

• TNFi, JAKi, and csDMARDs-only showed similar effectiveness during 12 months in naïve patients.

• ACPA status had no significant effect on the efficacy of TNFi, JAKi, and csDMARDs.

• The drug persistence of csDMARDs-only is better than that of JAKi and TNFi within 12 months.