Start RA treatment - Biologics or JAK-inhibitors?

Caporali, Roberto, Germinario, Sabino, Kacsándi, Dorottya, Choy, Ernest ORCID: https://orcid.org/0000-0003-4459-8609 and Szekanecz, Zoltán 2024. Start RA treatment - Biologics or JAK-inhibitors? Autoimmunity Reviews 23 (1) , 103429. 10.1016/j.autrev.2023.103429

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Abstract

Janus Kinase inhibitors (JAKi) have been approved for the treatment of Rheumatoid Arthritis (RA) for several years. They are the first oral advanced treatment with efficacy similar to, if not greater than, biologic agents. Recently, concerns over their safety was raised by the results from Oral Surveillance trial suggesting that tofacitinib, one of the JAKi, was associated with higher cardiovascular adverse events and malignancies than TNF inhibitors (TNFi). Since then, regulatory authorities have added warnings to the labels of JAKi. On this purpose, whether rheumatologists should use JAKi as first line advance treatment has become a controversial topic. Some rheumatologists have argued that biologics should be first line advance treatment since there are extensive effectiveness and safety data. In addition, with the advent of biosimilar drugs, they are the most cost-effective treatment. On the other hand, JAKi are very efficacious and are generally safe apart from older and high-risk patients. When TNFi are contraindicated and in certain RA patients ,especially when an oral drug is preferable, JAKi have significant advantage providing patients are involved in the decision-making process.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Elsevier
ISSN:	1568-9972
Date of First Compliant Deposit:	13 October 2023
Date of Acceptance:	24 August 2023
Last Modified:	08 Nov 2024 13:30
URI:	https://orca.cardiff.ac.uk/id/eprint/163188

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