{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T08:49:10Z","timestamp":1782204550881,"version":"3.54.5"},"reference-count":12,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aim<\/jats:title>\n                    <jats:p>Safety concerns and medication shortages may influence prescribing practices in rheumatology. This study aimed to explore the impact of Janus kinase inhibitor (JAKi) safety warnings and the COVID\u201019 pandemic on biologic and targeted\u2010synthetic disease\u2010modifying antirheumatic drug (b\/tsDMARD) prescription patterns from 2002 to 2024 in the western region of Melbourne.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective audit was conducted on data from rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients who attended Western Health and Western Rheumatology clinics between 2002 and January 2024 inclusive. b\/tsDMARD switching was analysed based on the first date of b\/tsDMARD prescription using interrupted time series analysis, with ethics approval granted by the Western Health Office for Research (HREC\/23\/WH\/101783).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 3124 new b\/tsDMARD prescriptions. Following the 2021 United States JAKi boxed warning, the JAKi prescription rate decreased to \u22120.04\/month (\u22120.20, 0.11) from 0.30\/month (0.18, 0.42),\n                      <jats:italic>P<\/jats:italic>\n                      =\u20090.002. Supply shortages during the COVID\u201019 pandemic led to 44 b\/tsDMARD switches. The most common cause of switching was inefficacy (32.6% of new prescriptions for AS, 42.6% for RA and 46.1% for PsA (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;\u20090.001)). Less than 5.4% of new prescriptions were from adverse events, underscoring b\/tsDMARD safety.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>b\/tsDMARD switches were primarily driven by inefficacy. Black box warning issuance led to decreased JAKi prescriptions. The COVID\u201019 pandemic led to minimal b\/tsDMARD switches. Switching due to adverse events was infrequent, highlighting the overall safety of b\/tsDMARDs in clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/imj.70455","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T10:11:12Z","timestamp":1777889472000},"page":"1059-1067","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Two decades of biologic and\n                    <scp>JAK<\/scp>\n                    inhibitor prescription patterns in the western region of Melbourne"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1742-3013","authenticated-orcid":false,"given":"Alexander","family":"Kwan","sequence":"first","affiliation":[{"name":"Rheumatology Unit, The University of Melbourne (Department of Medicine) Western Health, Footscray Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvina","family":"Ingrid","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, The University of Melbourne (Department of Medicine) Western Health, Footscray Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1597-9421","authenticated-orcid":false,"given":"Sara","family":"Vogrin","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, The University of Melbourne (Department of Medicine) Western Health, Footscray Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Luong","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, The University of Melbourne (Department of Medicine) Western Health, Footscray Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Jin","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, The University of Melbourne (Department of Medicine) Western Health, Footscray Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Brown","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, The University of Melbourne (Department of Medicine) Western Health, Footscray Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongzhe","family":"Li","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, The University of Melbourne (Department of Medicine) Western Health, Footscray Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Jiang","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, The University of Melbourne (Department of Medicine) Western Health, Footscray Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith K. T.","family":"Lim","sequence":"additional","affiliation":[{"name":"Rheumatology Unit, The University of Melbourne (Department of Medicine) Western Health, Footscray Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"U.S. Food and Drug Administration (homepage on the Internet).Janus Kinase (JAK) inhibitors: Drug Safety Communication \u2010 FDA Requires Warnings about Increased Risk of Serious Heart\u2010related Events Cancer Blood Clots and Death 2021(updated 9 January 2021; cited 4 July 2025). Available from URL:https:\/\/www.fda.gov\/safety\/medical\u2010product\u2010safety\u2010information\/janus\u2010kinase\u2010jak\u2010inhibitors\u2010drug\u2010safety\u2010communication\u2010fda\u2010requires\u2010warnings\u2010about\u2010increased\u2010risk."},{"key":"e_1_2_9_3_1","unstructured":"van derKallenJ KnottE GowlandA.Important safety information for Janus kinase (JAK) inhibitors 2023. [updated 11 May 2023; cited 4 July 2025]. Available from URL:https:\/\/www.tga.gov.au\/news\/safety-updates\/important-safety-information-janus-kinase-jak-inhibitors."},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1756-185X.15308"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/narmme\/ugaf017"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keac048"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2024.152421"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40744-020-00211-w"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40744-020-00203-w"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm13081199"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2021.105253"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70455","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/imj.70455","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70455","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T08:11:13Z","timestamp":1782202273000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.70455"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":12,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/imj.70455"],"URL":"https:\/\/doi.org\/10.1111\/imj.70455","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,4]]},"assertion":[{"value":"2025-07-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}