First-line use of JAKi was not associated with an increased risk of MACE compared with TNFi in Korean patients with RA, providing real-world evidence supporting the cardiovascular safety of JAKi as first-line advanced therapy.
The study cohort comprised 6174 Korean patients with newly diagnosed RA who started TNFi or JAKi as first-line advanced therapy.
Incidence rates of MACE were similar and low in both treatment groups.
In the total cohort, MACE risk did not differ significantly between JAKi and TNFi.
In the propensity score-matched population, MACE risk also did not differ significantly between JAKi and TNFi.
Findings were consistent across all prespecified subgroups, including patients with baseline cardiovascular risk factors.
The authors conclude that first-line JAKi use was not associated with increased MACE risk compared with TNFi.
This study used Korea's nationwide health insurance claims data to compare heart and stroke risks in people with rheumatoid arthritis (RA) who started one of two types of advanced medication as their first such treatment: TNF inhibitors (an older class of biologic drugs) or JAK inhibitors (newer pills). It followed 6174 patients, of whom 5152 took TNF inhibitors and 1022 took JAK inhibitors, for up to about a decade. The outcome was a major cardiovascular event: heart attack, ischaemic stroke, or a procedure to reopen heart arteries. Major cardiovascular events were uncommon in both groups, at about 4.1 per 1000 person-years with TNF inhibitors and 3.6 per 1000 person-years with JAK inhibitors. After statistical adjustment, and also after matching similar patients, JAK inhibitor users did not have a significantly higher risk than TNF inhibitor users. The results were similar in subgroups, including patients who already had cardiovascular risk factors. This research suggests that, when used as a first advanced therapy, JAK inhibitors did not show more cardiovascular risk than TNF inhibitors in this population. However, there were few events, so the statistical ranges were wide and a modest difference in risk cannot be ruled out. The study is observational and based on claims data, so it cannot prove cause and effect.
Kwon O, Lee H, Jeon S, Park M. (2026). Cardiovascular risk associated with first-line Janus kinase inhibitors versus TNF inhibitors in patients with RA: a nationwide cohort study.. Rheumatology (Oxford, England). https://doi.org/10.1093/rheumatology/keag582