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Original article Risk of cancer, cardiovascular disease, thromboembolism, and mortality in patients with rheumatoid arthritis receiving Janus kinase inhibitors: a real-world retrospective observational study using Korean health insurance data
Hong Ki Min2orcid , Hyeongsu Kim1orcid , Ho Jin Jeong1orcid , Se Hee Kim2orcid , Hae-Rim Kim1orcid , Sang-Heon Lee1orcid , KunSei Lee1orcid , Soon-Ae Shin3orcid , Jong Heon Park3orcid
Epidemiol Health 2023;e2023045
DOI: https://doi.org/10.4178/epih.e2023045 [Accepted]
Published online: April 15, 2023
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1Department of Preventive Medicine, Konkuk University School of Medicine, Seoul, Korea
2Konkuk University Medical Center, Seoul, Korea
3National Health Insurance Service, Wonju, Korea
Corresponding author:  Hyeongsu Kim,
Email: mubul@kku.ac.kr
Received: 15 December 2022   • Revised: 29 March 2023   • Accepted: 5 April 2023
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Abstract

Objectives
This study investigated whether Janus kinase inhibitors (JAKis) raise the risk of cardiovascular disease (CVD), venous thromboembolism (VTE), and cancer in patients with rheumatoid arthritis (RA).
Methods
We conducted a real-world retrospective observational study using data obtained from the Korean National Health Insurance Service database. Two data sets were analyzed: tumor necrosis factor inhibitor (TNFi)/JAKi-naive RA patients (set 1) and all RA patients who used TNFis or JAKis (set 2). The incidence rate ratios (IRRs) and hazard ratios (HRs) for acute myocardial infarction (AMI), stroke, CV-related mortality, major adverse cardiovascular events (MACE), VTE, arterial thromboembolism (ATE), cancer, and all-cause mortality were compared between the JAKi and TNFi groups.
Results
Set 1 included 1,596 RA patients (JAKi group: 645; TNFi group: 951), and set 2 included 11,765 RA patients (JAKi group: 2,498; TNFi group: 9,267). No adverse events (AEs) showed significantly higher IRRs in the JAKi groups than in the TNFi groups of sets 1 and 2. The HRs for MACE in the JAKi groups of sets 1 and 2 were 0.59 (95% CI, 0.35–0.99) and 0.80 (95% CI, 0.67–0.97), respectively. The JAKi group of set 2 showed a significantly higher risk of all-cause mortality (HR=1.71; 95% CI, 1.32–2.2), but the other AEs did not demonstrate increased risks in the JAKi groups.
Conclusions
In this study, JAKis did not increase the risk of AMI, stroke, CV-related mortality, MACE, VTE, ATE, or cancer in Korean RA patients relative to TNFis.

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