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Efficacy of Janus kinase inhibitors in rheumatoid arthritis

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Abstract

Background

Janus kinase inhibitors (JAKis) is a new therapeutic class in autoimmune and inflammatory diseases. Four molecules are approved in rheumatoid arthritis (RA) in Europe. Recently, questions have raised about adverse events. In this context, a synthesis of the efficacy data of JAKis in RA is of use.

Method

We performed a literature review based on published articles about efficacy of JAKis in RA, including clinical trials, registries, retrospective and prospective cohorts as well as database analysis.

Results

Based on the phase III clinical trials, JAKis are effective in comparison to placebo, methotrexate and tumour necrosis factor inhibitors. Based on registries, cohorts and post hoc analysis of phase III clinical trials, several parameters might modulate the efficacy of JAKis: the serological status, a short duration of the disease or the presence of poor prognostic factors. Preliminary data suggest that early ultrasonographic evaluation might help to predict the medium-term progression.

Conclusion

Some clinical, biological and imaging parameters seem to influence the response to JAKis and should be evaluated in larger studies. In addition to factors that might influence the efficacy of JAKis, the safety profile and risk factors should be considered before initiating JAKis in a patient.

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Abbreviations

ACPA:

Anti-citrullinated peptide antibodies

DMARD:

Disease modifying anti-rheumatic drugs

csDMARD:

Conventional synthetic DMARD

bDMARD:

Biological DMARD

HAQ-DI:

Health assessment questionnaire-disability index

JAK:

Janus kinase

JAKis:

Janus kinase inhibitors

mTTS:

Modified total sharp score

MSUS:

Musculoskeletal ultrasonography

MTX:

Methotrexate

NA:

Not available

QALY:

Quality-adjusted life-years

RA:

Rheumatoid arthritis

RF:

Rheumatoid factor

TNFα:

Tumor necrosis factor α

TNFi:

TNF inhibitors

TYK:

Tyrosine kinase

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Authors and Affiliations

  1. Service de Rhumatologie, CHRU de Tours, Bd Tonnelé, 37000, Tours, France

    Camille Langbour, Jessica Rene, Philippe Goupille & Guillermo Carvajal Alegria

  2. Université de Tours, Tours, France

    Jessica Rene, Philippe Goupille & Guillermo Carvajal Alegria

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  1. Camille Langbour
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  2. Jessica Rene
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  3. Philippe Goupille
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  4. Guillermo Carvajal Alegria
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Contributions

CL and GCA did the selection of the articles and the structure of the article. CL, GCA, JR, and PG participated in the writing of the main text, the tables, and the figures. All authors read and approved the final manuscript.

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Correspondence to Guillermo Carvajal Alegria.

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Conflict of interest

P Goupille: research grants, consultation fees, or speaker honoraria: AbbVie, Amgen, Biogen, BMS, Boehringer Ingelheim, Chugai, Galapagos, Janssen, Lilly, MSD, Novartis, Pfizer, Sanofi and UCB. G Carvajal Alegria: research grants, consultation fees, or speaker honoraria: AbbVie, Biogen, BMS, Chugai, Galapagos, Lilly, MSD, Novartis, Pfizer. CL and JR: no competing interest to declare.

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Langbour, C., Rene, J., Goupille, P. et al. Efficacy of Janus kinase inhibitors in rheumatoid arthritis. Inflamm. Res. 72, 1121–1132 (2023). https://doi.org/10.1007/s00011-023-01717-z

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