JAK Inhibitors and the Risk of Malignancy: A Meta-analysis Across Disease Indications

Ann Rheum Dis. 2023;82(8):1059–1067 doi: 10.1136/ard-2023-224049

The objective of this study was to estimate the association of JAKi with the incidence of malignancy, compared with placebo, TNFi and MTX.

Reinisch, et al. show that filgotinib treatment has no effect on semen parameters for men with active inflammatory diseases. This contrasts with pre-clinical studies that showed fertility issues in male animals.

May 2023

Ixekizumab, has been shown to be efficacious against paradoxical palmoplantar pustulosis which has been reported following the administration of therapeutic TNFi. Following the increased use of biologic therapies that improve patients’ quality of life are causing paradoxical adverse effects

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A prospective observational study showed that recombinant zoster vaccine (RZV) immunogenicity is not impaired in RA patients on JAK inhibitors or anti-cellular bDMARDs.

Investigators from a phase 2 study concluded that further investigation with BMS-986142 (a novel BTK) in people with RA is not necessary.

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Evidence from two phase 3 RCTs showed that patients with PsA and axial involvement had greater responses when treated with a once-daily oral dose of 15 mg upadacitinib versus placebo, and a similar or greater response versus adalimumab. Safety results were comparable between patients with or without axial involvement.

April 2023

Findings from a post hoc analysis of ORAL Surveillance can help guide individualised benefit/risk assessment and clinical decision-making on treatment with tofacitinib, based on identification of subpopulations ‘at risk’.

Retrospective cohort study results suggest that treatment with tofacitinib, and perhaps other JAK inhibitors, may provide a benefit in reducing the risk of developing RA-Interstitial Lung Disease (ILD).

Evidence from two phase 3 RCTs and one LTE shows that while tofacitinib efficacy exceeds placebo in both sexes and is comparable between sexes, males are more likely to achieve minimal disease activity than females.

TNF inhibitors (TNFi) are one main mode of therapy in patients with PsA who fail to respond to csDMARDs. However, they have a primary treatment failure rate of 40% and only a modest target of ≥20% ACR20 response. The objective of this study was to evaluate efficacy and safety of guselkumab, interleukin-23 inhibitor in the DISCOVER-1 study with active PsA patients by prior use of TNFi.