Impact of BMI on response to Janus kinase inhibitors in rheumatoid arthritis: an individual patient data meta-analysis of randomised controlled trials
Abstract
Background: Obesity is common in patients with rheumatoid arthritis and is associated with poorer disease outcomes. We aimed to evaluate the association between BMI and clinical response to Janus kinase (JAK) inhibitors in patients with rheumatoid arthritis using individual patient data from the JAK inhibitor randomised controlled trial programmes.
Methods: In this individual patient data meta-analysis, ClinicalTrials.gov was searched from database inception to Jan 13, 2025, for phase 3, randomised controlled trials of tofacitinib, baricitinib, upadacitinib, and filgotinib in adult patients with rheumatoid arthritis, with a placebo or active comparator. Individual patient data were obtained via the Vivli data-sharing platform. The primary outcomes were a 20% improvement based on American College of Rheumatology (ACR) core set variables (ACR20) and Disease Activity Score based on the evaluation of 28 joints and C-reactive protein (DAS28-CRP), at the trial-defined primary efficacy timepoint. BMI was analysed as a continuous and categorical variable using one-stage mixed-effects models, and validated using a two-stage individual patient data meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. There was no involvement of people with lived experience in the study design or conduct. This study is registered with PROSPERO (CRD420251180005).
Findings: 16 trials contributed individual patient data from 11 883 participants (9588 [80·7%] women and 2293…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 11 participants or records.
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