JAK Inhibitors in Rheumatoid Arthritis: An Evidence-Based Review on the Emerging Clinical Data

Robert Harrington,* Shamma Ahmad Al Nokhatha,* Richard Conway Department of Rheumatology, St. James’s Hospital, Dublin, Ireland*These authors contributed equally to this workCorrespondence: Richard ConwayDepartment of Rheumatology, St. James’s Hospital, Dublin, IrelandEmail drric...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Harrington R, Al Nokhatha SA, Conway R
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	rheumatoid arthritis immunosuppressive therapies jak inhibitors targeted synthetic dmard tsdmard Pathology RB1-214 Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/fecb9d1c8873496db890a1eafdd3a753
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:fecb9d1c8873496db890a1eafdd3a753
record_format	dspace
spelling	oai:doaj.org-article:fecb9d1c8873496db890a1eafdd3a7532021-12-02T10:11:30ZJAK Inhibitors in Rheumatoid Arthritis: An Evidence-Based Review on the Emerging Clinical Data1178-7031https://doaj.org/article/fecb9d1c8873496db890a1eafdd3a7532020-09-01T00:00:00Zhttps://www.dovepress.com/jak-inhibitors-in-rheumatoid-arthritis-an-evidence-based-review-on-the-peer-reviewed-article-JIRhttps://doaj.org/toc/1178-7031Robert Harrington,* Shamma Ahmad Al Nokhatha,* Richard Conway Department of Rheumatology, St. James’s Hospital, Dublin, Ireland*These authors contributed equally to this workCorrespondence: Richard ConwayDepartment of Rheumatology, St. James’s Hospital, Dublin, IrelandEmail drrichardconway@gmail.comAbstract: Janus kinase (JAK) Inhibitors are the latest drug class of disease-modifying medication to emerge for the treatment of rheumatoid arthritis (RA). They are a small molecule-targeted treatment and are the first oral option to compare favourably to existing biologic disease-modifying anti-rheumatic drugs (DMARDs). Tofacitinib, baricitinib and upadacitinib are the first 3 JAK inhibitors to become commercially available in the field and are the core focus of this review. To date, they have demonstrated comparable efficacy to tumour necrosis factor (TNF) inhibitors in terms of American College of Rheumatology (ACR) response rates and disease activity (DAS28) scores with similar cost to the benchmark adalimumab. This narrative review article aims to synthesise and distil the key available trial data on JAK inhibitor efficacy and safety, along with their place in the ACR and European League Against Rheumatism (EULAR) guidelines for RA. The novel mechanism of action of the JAK/STAT pathway is highlighted along with the potential effects of modulating each pathway. The rapid onset of action, role in attenuation of central pain processing and effect on structural damage and radiographic progression are also all examined in detail. We also explore the latest meta-analyses and comparative performance of each of the 3 available JAKs in an effort to determine which is most efficacious and which has the most favourable safety profile. Post marketing concerns regarding thromboembolism risk and herpes zoster infection are also discussed. Additionally, we review the cost-benefit analyses of the available JAK inhibitors and address some of the pharmacoeconomic considerations for real-world practice in the UK and US by detailing the raw acquisition cost and the value they provide in comparison to the benchmark biologic adalimumab and the anchor DMARD methotrexate.Keywords: rheumatoid arthritis, immunosuppressive therapies, JAK inhibitors, targeted synthetic DMARD, tsDMARDHarrington RAl Nokhatha SAConway RDove Medical Pressarticlerheumatoid arthritisimmunosuppressive therapiesjak inhibitorstargeted synthetic dmardtsdmardPathologyRB1-214Therapeutics. PharmacologyRM1-950ENJournal of Inflammation Research, Vol Volume 13, Pp 519-531 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	rheumatoid arthritis immunosuppressive therapies jak inhibitors targeted synthetic dmard tsdmard Pathology RB1-214 Therapeutics. Pharmacology RM1-950
spellingShingle	rheumatoid arthritis immunosuppressive therapies jak inhibitors targeted synthetic dmard tsdmard Pathology RB1-214 Therapeutics. Pharmacology RM1-950 Harrington R Al Nokhatha SA Conway R JAK Inhibitors in Rheumatoid Arthritis: An Evidence-Based Review on the Emerging Clinical Data
description	Robert Harrington,* Shamma Ahmad Al Nokhatha,* Richard Conway Department of Rheumatology, St. James’s Hospital, Dublin, Ireland*These authors contributed equally to this workCorrespondence: Richard ConwayDepartment of Rheumatology, St. James’s Hospital, Dublin, IrelandEmail drrichardconway@gmail.comAbstract: Janus kinase (JAK) Inhibitors are the latest drug class of disease-modifying medication to emerge for the treatment of rheumatoid arthritis (RA). They are a small molecule-targeted treatment and are the first oral option to compare favourably to existing biologic disease-modifying anti-rheumatic drugs (DMARDs). Tofacitinib, baricitinib and upadacitinib are the first 3 JAK inhibitors to become commercially available in the field and are the core focus of this review. To date, they have demonstrated comparable efficacy to tumour necrosis factor (TNF) inhibitors in terms of American College of Rheumatology (ACR) response rates and disease activity (DAS28) scores with similar cost to the benchmark adalimumab. This narrative review article aims to synthesise and distil the key available trial data on JAK inhibitor efficacy and safety, along with their place in the ACR and European League Against Rheumatism (EULAR) guidelines for RA. The novel mechanism of action of the JAK/STAT pathway is highlighted along with the potential effects of modulating each pathway. The rapid onset of action, role in attenuation of central pain processing and effect on structural damage and radiographic progression are also all examined in detail. We also explore the latest meta-analyses and comparative performance of each of the 3 available JAKs in an effort to determine which is most efficacious and which has the most favourable safety profile. Post marketing concerns regarding thromboembolism risk and herpes zoster infection are also discussed. Additionally, we review the cost-benefit analyses of the available JAK inhibitors and address some of the pharmacoeconomic considerations for real-world practice in the UK and US by detailing the raw acquisition cost and the value they provide in comparison to the benchmark biologic adalimumab and the anchor DMARD methotrexate.Keywords: rheumatoid arthritis, immunosuppressive therapies, JAK inhibitors, targeted synthetic DMARD, tsDMARD
format	article
author	Harrington R Al Nokhatha SA Conway R
author_facet	Harrington R Al Nokhatha SA Conway R
author_sort	Harrington R
title	JAK Inhibitors in Rheumatoid Arthritis: An Evidence-Based Review on the Emerging Clinical Data
title_short	JAK Inhibitors in Rheumatoid Arthritis: An Evidence-Based Review on the Emerging Clinical Data
title_full	JAK Inhibitors in Rheumatoid Arthritis: An Evidence-Based Review on the Emerging Clinical Data
title_fullStr	JAK Inhibitors in Rheumatoid Arthritis: An Evidence-Based Review on the Emerging Clinical Data
title_full_unstemmed	JAK Inhibitors in Rheumatoid Arthritis: An Evidence-Based Review on the Emerging Clinical Data
title_sort	jak inhibitors in rheumatoid arthritis: an evidence-based review on the emerging clinical data
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/fecb9d1c8873496db890a1eafdd3a753
work_keys_str_mv	AT harringtonr jakinhibitorsinrheumatoidarthritisanevidencebasedreviewontheemergingclinicaldata AT alnokhathasa jakinhibitorsinrheumatoidarthritisanevidencebasedreviewontheemergingclinicaldata AT conwayr jakinhibitorsinrheumatoidarthritisanevidencebasedreviewontheemergingclinicaldata
_version_	1718397569138163712

JAK Inhibitors in Rheumatoid Arthritis: An Evidence-Based Review on the Emerging Clinical Data

Ejemplares similares