Studying Dose Reduction Versus Continued Use of Janus Kinase Inhibitors for Rheumatoid Arthritis, Psoriatic Arthritis, and Axial Spondyloarthritis in Patients with Low Disease Activity

What this Trial Is About

Researchers are evaluating whether reducing the dose of Janus kinase inhibitors JAKi based on disease activity is as effective as continuing the same dose in patients with rheumatoid arthritis RA, psoriatic arthritis PsA, and axial spondyloarthritis axSpA who currently have low disease activity or are in remission. This study addresses concerns about the risks and costs associated with JAKi treatment, including infection, cardiovascular disease, and cancer. The study also aims to assess feasibility, safety, cost-effectiveness, and identify biomarkers related to dose reduction success. Participants will be assigned either to a stepwise JAKi dose reduction group or to continue their current JAKi dose. Dose reductions occur every three months with specific tapering steps outlined for different JAKi medications, such as Baricitinib, Filgotinib, Tofacitinib, and Upadacitinib. If disease activity flares, the dose is increased back to the last effective level and maintained. The control group continues usual care with their standard dosing. All participants are monitored every three months, with additional visits if needed. During the 12-month follow-up, participants complete questionnaires every three months about their daily functioning, quality of life, pain, fatigue, productivity, medical use, and medication adherence. Researchers will measure the proportion of patients maintaining low disease activity, disease activity scores specific to each condition, adverse events, flare incidence, medication use, cost-effectiveness, and potential predictors for successful dose reduction. The study includes telemonitoring visits and allows for treatment adjustment in response to symptoms.

REDO-JAK: Dose Reduction of Janus Kinase Inhibitors in Patients With Inflammatory Rheumatic Diseases