Sequential disease activity assessment for predicting future treatment trajectories in patients with rheumatoid arthritis treated with JAK inhibitors: a group-based trajectory and landmark analysis.

Authors

Kenya Terabe, Shuji Asai, Yutaka Yoshioka, Takefumi Kato, Toshihisa Kojima, Tomonori Kobayakawa, Tatsuo Watanabe, Yasumori Sobue, Tsuyoshi Nishiume, Takuya Matsumoto, Ryo Nakashima, Mihoko Kato, Takayoshi Fujibayashi, Yuji Hirano, Yasuhide Kanayama, Yusuke Ono, Tsuyoshi Watanabe, Masahiro Hanabayashi, Hiroyuki Matsubara, Yoshifumi Ohashi, Mochihito Suzuki, Takahiro Imaizumi, Nobunori Takahashi, Shiro Imagama

Published in

Annals of the rheumatic diseases. Sep 10, 2026. Epub Sep 10, 2026.

Abstract

This study aimed to identify disease activity trajectories in patients with rheumatoid arthritis (RA) treated with Janus kinase (JAK) inhibitors and to determine whether early disease activity improved prediction of long-term treatment trajectories.
We analysed 843 patients treated with JAK inhibitors from a multicentre registry. Group-based trajectory modelling was used to identify distinct Clinical Disease Activity Index (CDAI) trajectories over 52 weeks. Landmark analyses at weeks 4 and 12 were performed using multivariate logistic regression with multiple imputations. Model performance was evaluated using the area under the receiver operating characteristic curve, Brier score, and bootstrap-based internal validation.
Four distinct trajectory groups were identified: rapid responders (64.9%), partial responders with persistent residual disease activity (18.1%), responders with high baseline disease activity (12.7%), and persistent nonresponders (4.3%). Week-52 remission rates ranged from 0.0% to 47.7% across the groups. Incorporating the CDAI at landmark time points substantially improved the prediction of a favourable trajectory, whereas the CDAI slope provided minimal additional predictive value. Brier scores improved markedly after incorporating week-12 CDAI, with minimal further improvement after CDAI slope inclusion. Bootstrap validation demonstrated minimal optimism and good calibration. The optimal CDAI thresholds for predicting a favourable trajectory were 12.0 and 9.3 at weeks 4 and 12, respectively.
Early disease activity dynamically refined the prediction of future treatment trajectories in patients with RA treated with JAK inhibitors. The absolute CDAI at landmark time points was more informative than change-based metrics, supporting sequential disease activity assessment for time-anchored treatment decision-making.

PMID:
42722589
Bibliographic data and abstract were imported from PubMed on 11 Sep 2026.

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