Efficacy and safety of JAK inhibitors in rheumatoid arthritis: update for the practising clinician

Nat Rev Rheumatol 2024;20(2):101–115 DOI: 10.1038/s41584-023-01062-9

The observed benefit:risk ratio strongly favours JAKi use in the majority of patients, and HCPs should consider and adhere to guidance on high-risk patients where applicable. Szekanecz et al summarised the safety and efficacy of approved JAKis tofacitinib, baricitinib, upadacitinib, and filgotinib to aid in clinical decision making.

Therapeutic intervention during the at-risk phase of RA with abatacept is feasible, with acceptable safety profiles. However, the efficacy of intermittent administration at multiple intervals remains to be assessed.

This pooled analysis of four Phase 3 RCTs investigated the long-term efficacy baricitinib in patients with active RA who were MTX-IR, csDMARD-IR, or bDMARD-IR. They found that baricitinib demonstrated efficacy up to 6.5 years and was well tolerated.

Kwon, et al. found that adalimumab exposure significantly reduced risk of incident and recurrent acute anterior uveitis (AAU) versus etanercept exposure and bDMARD non-exposure. Furthermore, exposure to etanercept significantly increased risk of incident and recurrent AAU versus bDMARD non-exposure.

Effectiveness of Sequential Lines of Biologic and Targeted Small Molecule Drugs in Psoriatic Arthritis: A Systematic Review

Rheumatology (Oxford). 2024 Jan 18:keae006 doi: 10.1093/rheumatology/keae006 Epub ahead of print

The authors found that there is a reduction in effectiveness of lines of bDMARDs after first-line in PsA, with inadequate data to determine response to tsDMARDs.

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January 2024

Cardiovascular Safety of Janus Kinase Inhibitor Therapy in a Multi-ethnic Population

Musculoskeletal Care 2023 doi 10.1002/msc.1853 Epub ahead of print

This study by Sunmboye, et al. investigated the relationship between CV event incidence and age in a multi-ethnic population that received JAK inhibitor therapy. They concluded that JAK inhibitor therapy was generally safe in a multi-ethnic population with a large age range, but they did find a statistically significant but numerically small positive correlation between age and CV incidence

Adalimumab demonstrated superiority over placebo in reducing fatigue in RA at 12 and 52 weeks. Other interventions, which included golimumab, baricitinib, sarilumab, tocilizumab, and tofacitinib, also proved effective in reducing fatigue in patients with RA. Secukinumab also reduced fatigue by Week 52 in patients with SpA.

These recommendations from EULAR provide consensus and up-to-date guidance on fatigue management in people with I-RMDs, which includes advice regarding pharmacological and non-pharmacological interventions.

Siderius, et al. found that secukinumab was associated with low spinal radiographic progression. Furthermore, bone-related outcomes and BTMs related to collagen resorption (sCTX, PINP) remained constant during the 2-year period, whereas the BTM related to mineralisation (BALP) decreased significantly.

The Risk Factors for Uveitis Among Psoriatic Arthritis Patients: A Population-based Cohort Study

Clin Rheumatol. 2023;43(3):1053–1061 doi: 10.1007/s10067-023-06834-y

Retrospective matched cohort study concludes that PsA is associated with increased risk of uveitis, with past uveitis and treatment with etanercept being independently associated with a higher risk of uveitis. Patients who developed uveitis were mainly treated with topical glucocorticoids.