Real-World Study Shows JAK Inhibitors Are Effective in Treating Rheumatoid Arthritis
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Over the past decade, patients with moderate to severe rheumatoid arthritis who have not had success with established treatments have been able to turn to a new class of drugs called Janus kinase (JAK) inhibitors.
These medications work by disrupting signals in the body that are thought to cause inflammation. While randomized controlled trials have demonstrated their effectiveness, a new study confirms that these drugs can significantly reduce or eliminate disease activity in patients in a “real-world” setting.
For the research, published November 1 in the journal Rheumatology, scientists in Japan evaluated four JAK inhibitors, including three approved for use in the United States: baricitinib (Olumiant), tofacitinib (Xeljanz), and upadacitinib (Rinvoq).
“We found that most patients have success with these medications, and the efficacy and safety of each of these JAK inhibitors was not significantly different in the treatment of rheumatoid arthritis,” says the lead study author, Shinya Hayashi, MD, a rheumatology specialist in the department of orthopedic surgery at Kobe University in Japan. “These medications offer options when biologic disease-modifying antirheumatic drugs (DMARDS) have failed.”
According to the Arthritis Foundation, biologic DMARDs, which are administered through injection or infusion, may be prescribed when conventional DMARDs, such as methotrexate, are not controlling the disease. JAK inhibitors, which are taken orally, provide yet another possible therapy to manage pain, stiffness, fatigue, and other disease symptoms.
The researchers indicated that in practice, doctors mostly prescribe JAK inhibitors when patients have other health problems that can make conventional drugs like methotrexate less effective. Real-world patients have characteristics distinct from those of patients recruited in randomized controlled trials.
‘Impressive’ Reductions in Disease Activity for RA Patients Taking JAK Inhibitors
For this latest study, Dr. Hayashi and colleagues looked at data from more than 600 rheumatoid arthritis patients treated with JAK inhibitors at seven major university hospitals in Japan.
The researchers observed that about 1 in 3 patients reached remission — meaning no visible signs or symptoms — while 3 out of 4 patients reached at least low disease activity. Oxford University Press, which publishes Rheumatology, said in a press release that these numbers represent “impressive efficacy.”
The findings further highlighted that more than 80 percent of the patients were still on the JAK inhibitors after six months, and that these medications all worked equally well.
Because of this equal efficacy, study authors also suggest that some people with rheumatoid arthritis may find it beneficial to switch to another JAK inhibitor if one isn’t producing desired results.
JAK Inhibitors Come With Some Safety Concerns
Rajat Bhatt, MD, a rheumatologist with Memorial Hermann Health System in Richmond, Texas, indicates that these results align with positive outcomes he has seen in his patients who take JAK inhibitors.
“These medications have been very successful across a wide variety of indications — not only rheumatoid arthritis but also psoriatic arthritis and ankylosing spondylitis,” says Dr. Bhatt, who was not involved in the research.
While the study underscores the overall safety of JAK inhibitors, Bhatt notes concerns that they may produce side effects in some patients.
“They are usually safe in the short term, but they can cause liver function test elevations,” he says. “There have also been safety issues related to cardiac events.”
Bhatt adds that some insurance companies are restricting access to these medications because of these cardiac events.
In September 2021, after a review of clinical trial data, the U.S. Food and Drug Administration (FDA) warned of an increased risk of serious heart-related events such as heart attack or stroke, as well as cancer, blood clots, and death, for patients using JAK inhibitors.
“Health care professionals should counsel patients about the benefits and risks of these medicines,” wrote the FDA.
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