[PD Test 4]JAK inhibitors shown safe, effective in RA patients

A recent study has demonstrated the safety and efficacy of oral Janus kinase (JAK) inhibitors in patients with rheumatoid arthritis (RA) in the real-world setting, particularly in those who do not present with cardiovascular risk factors at baseline.

Previous research found that tofacitinib use resulted in a higher incidence of cardiovascular and neoplastic events compared to tumour necrosis factor inhibitors, according to the authors, who then investigated the safety and efficacy of JAK inhibitors in a multicentre cohort.

In the current study, a total of 685 patients with RA who had received at least one JAK inhibitor (tofacitinib, baricitinib, upadacitinib, or filgotinib) from four tertiary care centres in Milan, Italy, were retrospectively evaluated.

The authors recorded outcomes associated with JAK inhibitor safety, especially major cardiovascular events and adverse events of special interest (AESI), including serious infections, opportunistic infections, venous thromboembolism, herpes zoster infections, liver injury, malignancies, and deaths. They also calculated the retention rates.

Finally, patients fulfilling the risk factors suggested to influence the safety of tofacitinib were included in further analyses.

Of the 685 patients included, 48 percent received baricitinib, 31 percent tofacitinib, 14 percent upadacitinib, and 7 percent filgotinib as first-line treatment prior to a biologic.

Over 1,137 patient-years of observation, one stroke incident and 123 (18 percent) AESIs were recorded, including three deaths due to severe infections. In addition, the authors observed a greater frequency of AESIs (23 percent) among patients with a higher cardiovascular risk.

“Our study [however] could not identify differences between JAK inhibitors,” the authors said. “Different safety profiles should be defined in larger prospective cohorts.”