{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T19:49:30Z","timestamp":1777492170620,"version":"3.51.4"},"reference-count":46,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T00:00:00Z","timestamp":1717027200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the risk of gastrointestinal perforation (GIP), a rare but serious adverse event, in patients who a JAK inhibitor (JAKi; tofacitinib, baricitinib, upadacitinib, or filgotinib) versus adalimumab (tumor necrosis factor inhibitor) among a comprehensive real\u2010world population of patients with rheumatic diseases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a nationwide population\u2010based cohort study of the French national health data system, the exposed group that received a JAKi and the comparison group adalimumab. We included all individuals with a rheumatic disease who had their first dispensation of these treatments from July 2017 to December 2021. The primary endpoint was the occurrence of GIP (end of follow\u2010up May 2022). Weighted hazard ratios (wHRs) were estimated with the inverse probability of treatment weighting method to account for confounding factors. Concomitant administration of systemic glucocorticoids, nonsteroidal anti\u2010inflammatory drugs, and proton\u2010pump inhibitors were time\u2010varying variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cohort included 39,758 patients: 12,335 and 27,423 in the groups that received a JAKi and adalimumab (mean age 58.2 and 47.3 years; female 76% and 58%; rheumatoid arthritis 85.3% and 27.3%, and psoriatic arthritis\/axial spondyloarthritis 14.7% and 72.7%), respectively. During follow\u2010up, 38 and 42 GIPs occurred in the groups that received a JAKi and adalimumab groups; incidence rates were 2.1 (95% confidence interval [CI] 1.5\u20132.8) and 1.1 (95% CI 0.8\u20131.5) per 1,000 person\u2010years, respectively. Rates of GIP did not differ between the groups that received a JAKi and adalimumab: wHR 1.1 (95% CI 0.7\u20131.9; <jats:italic>P<\/jats:italic> = 0.65). Despite the lack of power in some subgroup analyses, results were consistent whatever the subgroup of a type of JAKi received or subgroup with a type of rheumatic disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this nationwide cohort study, the rates of GIPs did not differ between groups of patients who received JAKi and adalimumab treatment. These results need to be confirmed in other observational studies.<\/jats:p><jats:p><jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/art42862-toc-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p><\/jats:sec>","DOI":"10.1002\/art.42862","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T04:18:33Z","timestamp":1714709913000},"page":"1364-1376","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Risk of Gastrointestinal Perforation in Patients With Rheumatic Diseases Exposed to Janus Kinase Inhibitors Versus Adalimumab: A Nationwide Cohort Study"],"prefix":"10.1002","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0921-5142","authenticated-orcid":false,"given":"Lea","family":"Hoisnard","sequence":"first","affiliation":[{"name":"Henri Mondor Hospital, INSERM, and Paris Est Cr\u00e9teil University  Cr\u00e9teil France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoine","family":"Meyer","sequence":"additional","affiliation":[{"name":"French National Agency for Medicines and Health Products Safety, Saint\u2010Denis, France, and Bic\u00eatre University Hospital, Paris\u2010Saclay University  Le Kremlin Bic\u00eatre France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosemary","family":"Dray\u2010Spira","sequence":"additional","affiliation":[{"name":"French National Agency for Medicines and Health Products Safety  Saint\u2010Denis France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alain","family":"Weill","sequence":"additional","affiliation":[{"name":"French National Agency for Medicines and Health Products Safety  Saint\u2010Denis France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmoud","family":"Zureik","sequence":"additional","affiliation":[{"name":"French National Agency for Medicines and Health Products Safety  Saint\u2010Denis France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1267-5270","authenticated-orcid":false,"given":"Emilie","family":"Sbidian","sequence":"additional","affiliation":[{"name":"Henri Mondor Hospital, Cr\u00e9teil, France, INSERM, Cr\u00e9teil, France, Paris Est Cr\u00e9teil University, Cr\u00e9teil, France, French National Agency for Medicines and Health Products Safety, Saint\u2010Denis, France  Le Kremlin Bic\u00eatre 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