Study Comparing Reduced Dose Versus Full Dose JAK Inhibitor Treatment in Adults With Low Activity Rheumatoid Arthritis

What this Trial Is About

This research aims to evaluate the feasibility of reducing the dose of JAK inhibitors in patients with rheumatoid arthritis RA who have low disease activity. It compares patients who gradually decrease their JAK inhibitor dose with patients who continue taking the full dose. RA is an autoimmune disease causing joint inflammation and damage, and while treatments have improved, concerns exist about side effects and costs of JAK inhibitors, especially tofacitinib, which may increase risks like blood clots and infections. Participants are assigned to either a dose-tapering group or a continuous therapy group. The tapering involves reducing the JAK inhibitor dose by half every six months, with two steps depending on the specific drug used baricitinib, filgotinib, tofacitinib, or upadacitinib. If disease activity remains low, doses are further spaced out. Those in the continuous group maintain the full dose throughout the 12-month study. If a disease flare occurs, standardized rescue treatment with glucocorticoids and dose adjustments are provided. Participants visit the clinic every three months for checkups and tests, and keep a diary tracking their medication intake and symptoms. Researchers monitor the proportion of patients still taking JAK inhibitors after one year and record flare occurrences. Stable doses of other medications like sDMARDs or low-dose glucocorticoids are maintained during the study. The trial lasts up to four years, with ongoing safety and disease activity assessments to understand the effects of dose reduction.

JAK Inhibitor Dose TAPering Strategy Study