In a nutshell
This study investigated the effectiveness of Janus kinase (JAK) inhibitors in rheumatoid arthritis (RA). They found that JAK inhibitors were more effective than conventional RA drugs.
Some background
Rheumatoid arthritis (RA) is a chronic immune condition. RA causes painful inflammation in the joints. This leads to disability over time. RA is treated with disease-modifying anti-rheumatic drugs (DMARDs). The first line of treatment is conventional DMARDs (csDMARDs). CsDMARDs target multiple proteins and pathways to reduce inflammation. Over time, patients may not respond to csDMARDs. Targeted DMARDs (tDMARDs) are drugs that target specific proteins or enzymes.
Janus kinase (JAK) inhibitors are tDMARDs. They are relatively new drugs. Some target one JAK enzyme. Others target multiple JAKs. Tofacitinib (Xeljanz), upadacitinib (Rinvoq), and baricitinib (Olumiant) are JAK inhibitors. It is unclear if certain JAK inhibitors are more effective than others.
Methods & findings
This study included 11 clinical trial reports. These trials investigated JAK inhibitors compared to csDMARDs. The authors compared the response to treatment. This was using the American College of Rheumatology score (ACR). An ACR50 score represents the number of patients that achieve a 50% reduction in disease activity (DA). Monotherapy (MT, one drug) and combination therapy (CT) were investigated.
All JAK inhibitors were more effective than csDMARDs. In CT, upadacitinib (15 mg) had the highest ACR50 response at 12 weeks (43.4%). This was also observed at 24 weeks. CT involving tofacitinib (5 mg) had a 38.7% response at 12 weeks, followed by baricitinib 2 mg (37.1%) and 4 mg (36.7%).
In MT, upadacitinib had a slightly better ACR50 response compared to tofacitinib (38.5% vs. 30.4%).
The bottom line
The authors concluded that JAK inhibitors were more effective than conventional RA drugs.
The fine print
This study analyzed the effect of 24 weeks of treatment. The long-term effectiveness of JAK inhibitors is unclear. Long-term follow-up studies are needed.
What’s next?
If you have any concerns regarding RA management, please consult with your doctor.
Published By :
Advances in therapy
Date :
Apr 15, 2020
