Janus kinase inhibitors have therapeutic potential for patients with immune-mediated inflammatory diseases, and evidence of greater risks of cardiovascular disease and malignancy than with TNF inhibitors should be carefully considered before recommendations against their use are made. Assessment of the risk–benefit ratios in these patients can instead guide clinical decision-making.
Change history
02 April 2024
A Correction to this paper has been published: https://doi.org/10.1038/s41584-024-01112-w
References
Ytterberg, S. R. et al. Cardiovascular and cancer risk with tofacitinib in rheumatoid arthritis. N. Engl. J. Med. 386, 316–326 (2022).
Italian Drug Agency (AIFA). Important information note agreed with the European regulatory authorities and with the Italian Drug Agency (AIFA). https://www.aifa.gov.it/documents/20142/1804929/2023.03.16_NII_JAK_inibitori.pdf (2023).
Szekanecz, Z. et al. Efficacy and safety of JAK inhibitors in rheumatoid arthritis: update for the practising clinician. Nat. Rev. Rheumatol. https://doi.org/10.1038/s41584-023-01062-9 (2024).
Hansildaar, R. et al. Cardiovascular risk in inflammatory arthritis: rheumatoid arthritis and gout. Lancet Rheumatol. 3, e58–e70 (2021).
Kristensen, L. E. et al. Identification of two tofacitinib subpopulations with different relative risk versus TNF inhibitors: an analysis of the open label, randomised controlled study ORAL Surveillance. Ann. Rheum. Dis. 82, 901–910 (2023).
Drosos, G. C. et al. EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome. Ann. Rheum. Dis. 81, 768–779 (2022).
Smolen, J. S. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann. Rheum. Dis. 82, 3–18 (2023).
Visseren, F. L. J. et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur. Heart J. 42, 3227–3337 (2021).
Curtis, J. R. et al. Malignancy risk with tofacitinib versus TNF inhibitors in rheumatoid arthritis: results from the open-label, randomised controlled ORAL Surveillance trial. Ann. Rheum. Dis. 82, 331–343 (2023).
Cohen, S. B. et al. Long-term safety of tofacitinib up to 9.5 years: a comprehensive integrated analysis of the rheumatoid arthritis clinical development programme. RMD Open 6, e001395 (2020).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Rights and permissions
About this article
Cite this article
Ciccia, F., Caporali, R. Proposals for the rheumatological use of JAK inhibitors. Nat Rev Rheumatol 20, 65–66 (2024). https://doi.org/10.1038/s41584-023-01068-3
Published:
Issue Date:
DOI: https://doi.org/10.1038/s41584-023-01068-3
- Springer Nature Limited