{
  "abstract": "Introduction/objectives: To evaluate clinical effectiveness and treatment persistence after renal function-guided reduced-dose initiation of Janus kinase inhibitors (JAKis) in rheumatoid arthritis (RA).\n\nMethod: We analysed 368 adults initiating a JAKi in the ANSWER registry (2013–2023), classified as preserved renal function/standard dose (PR-Std; n = 246), preserved renal function/reduced dose (PR-Red; n = 68), or impaired renal function/reduced dose (IR-Red; n = 54). Outcomes were 6-month CDAI change, remission/LDA at days 84 and 168, and 12-month retention. IPTW addressed confounding; time-dependent Cox models evaluated dosing strategy × log(time + 1) interactions.\n\nResults: Weighting improved covariate balance (standardised mean differences ≤ 0.20; most ≤ 0.10). Six-month CDAI improvement was similar across groups, and no between-group contrast in ΔCDAI at days 28, 56, 84, or 168 reached statistical significance. At Day 168, IPTW-weighted low disease activity rates were 58.5% in PR-Std, 66.9% in PR-Red, and 68.2% in IR-Red, while remission rates were 21.7%, 19.9%, and 21.1%, respectively. IPTW-weighted 12-month retention was 0.53, 0.67, and 0.44, respectively. Adverse-event-related discontinuation was not clearly higher with reduced-dose initiation.\n\nConclusions: Reduced-dose initiation showed no clear differences in 6-month CDAI outcomes or 12-month persistence versus standard-dose initiation; however, the modest reduced-dose sample sizes and wide CIs preclude excluding small but clinically meaningful differences. Because systematic safety outcomes were not captured, AE-related discontinuation should be interpreted only as a proxy for tolerability.\n\nKey Points\n\n• Renal function-guided reduced-dose initiation of JAK inhibitors showed no clear differences in 6-month CDAI outcomes compared with standard-dose initiation.\n\n• Remission and low disease activity rates at days 84 and 168 were broadly similar across dosing groups.\n\n• In patients with preserved renal function, reduced-dose initiation showed numerically higher 12-month retention, although absolute differences were modest.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10067-026-08448-6.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, 1-14-1 Mihara-dai, Minami-ku, Sakai, Osaka 590-0197 Japan",
    "Department of Health Information Management, Kurashiki Sweet Hospital, Kurashiki, Okayama Japan",
    "Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan",
    "Department of Clinical Immunology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan",
    "Department of Orthopaedic Surgery, Faculty of Medicine, Graduate School of Medicine, The University of Osaka, Suita, Osaka Japan",
    "Department of Sports Medical Biomechanics, Faculty of Medicine, Graduate School of Medicine, The University of Osaka, Suita, Osaka Japan",
    "Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe, Hyogo Japan",
    "First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka Japan",
    "Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical University, Takatsuki, Osaka Japan"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 22,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Daisuke Tomita",
      "orcid": "0000-0001-9762-5055"
    },
    {
      "affs": [
        0
      ],
      "name": "Yuji Nozaki",
      "orcid": "0000-0003-2810-1519"
    },
    {
      "affs": [
        0
      ],
      "name": "Rika Fukuda"
    },
    {
      "affs": [
        0
      ],
      "name": "Yumi Morimoto"
    },
    {
      "affs": [
        0
      ],
      "name": "Hirotaka Yamazawa"
    },
    {
      "affs": [
        0
      ],
      "name": "Kaori Ishimura"
    },
    {
      "affs": [
        0
      ],
      "name": "Chisato Ashida"
    },
    {
      "affs": [
        0
      ],
      "name": "Tetsu Itami"
    },
    {
      "affs": [
        0
      ],
      "name": "Toshihiko Shiga"
    },
    {
      "affs": [
        1
      ],
      "name": "Wataru Yamamoto",
      "orcid": "0000-0002-0810-4221"
    },
    {
      "affs": [
        2
      ],
      "name": "Koichi Murata",
      "orcid": "0000-0002-7896-3937"
    },
    {
      "affs": [
        2
      ],
      "name": "Hideo Onizawa",
      "orcid": "0009-0002-9372-726X"
    },
    {
      "affs": [
        3
      ],
      "name": "Motomu Hashimoto",
      "orcid": "0000-0002-9241-060X"
    },
    {
      "affs": [
        3
      ],
      "name": "Masao Katsushima",
      "orcid": "0009-0007-0033-1757"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Kosuke Ebina",
      "orcid": "0000-0002-2426-1024"
    },
    {
      "affs": [
        6
      ],
      "name": "Iku Shirasugi",
      "orcid": "0009-0004-4668-1718"
    },
    {
      "affs": [
        6
      ],
      "name": "Yo Ueda",
      "orcid": "0000-0001-6065-8486"
    },
    {
      "affs": [
        7
      ],
      "name": "Yonsu Son",
      "orcid": "0000-0001-7244-7715"
    },
    {
      "affs": [
        7
      ],
      "name": "Naofumi Yoshida",
      "orcid": "0000-0002-7015-377X"
    },
    {
      "affs": [
        8
      ],
      "name": "Tohru Takeuchi",
      "orcid": "0000-0002-0065-929X"
    },
    {
      "affs": [
        8
      ],
      "name": "Shogo Matsuda",
      "orcid": "0000-0003-0023-3616"
    },
    {
      "affs": [
        0
      ],
      "name": "Koji Kinoshita",
      "orcid": "0000-0003-1809-5143"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4wbx341xqpj5d.bib",
  "cited_by": 0,
  "doi": "10.1007/s10067-026-08448-6",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13723485/",
  "id": "4wbx341xqpj5d",
  "issns": [
    "0770-3198",
    "1434-9949"
  ],
  "landing_url": "https://doi.org/10.1007/s10067-026-08448-6",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2745|Rheumatoid Arthritis Research and Therapies"
    ]
  ],
  "openalex": "W7214579873",
  "pdf_url": "https://link.springer.com/content/pdf/10.1007/s10067-026-08448-6.pdf",
  "pmcid": "PMC13723485",
  "pmid": "42806188",
  "published": "2026-09-29",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/4wbx341xqpj5d.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T12:22:06Z",
      "native_id": "PMC13723485",
      "source": "pmc",
      "url": "https://doi.org/10.1007/s10067-026-08448-6"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2745|Rheumatoid Arthritis Research and Therapies",
      "subfield": "general"
    }
  ],
  "title": "Renal function–adjusted initial JAK inhibitor dosing and outcomes in rheumatoid arthritis: from the ANSWER cohort study",
  "title_text": "Renal function–adjusted initial JAK inhibitor dosing and outcomes in rheumatoid arthritis: from the ANSWER cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T12:20:17Z",
  "url": "https://research.draconitic.com/paper/4wbx341xqpj5d",
  "venue": "Clinical Rheumatology",
  "versions": []
}