VIDEO: Benefits, concerns of JAK inhibitor use in RA

Editor’s note: This is a previously posted video, and the below is an automatically generated transcript to be used for informational purposes. Please notify dstatman@healio.com if there are concerns regarding accuracy of the transcription.

Of the JAK inhibitors; this has totally change our practice. These drugs are small, efficacious molecules that basically pack the punch of a biologic in a tiny little pill. We don't have to worry about needles, we don't have to worry about refrigeration and it works fast. Most of our therapies can take months to kick in, on average anywhere from three months, and the JAK inhibitors you can actually see efficacy within two weeks. But the problem is, recently, with the oral surveillance trial, there's been warnings about cardiovascular risks, malignancy, as well as venothrombolic events. So the FDA actually had slapped a warning on all JAK inhibitors based on a study by Pfizer using tofacitinib. And so the EULAR 2022 guidelines, what they did was that they put a caveat about when to use JAK inhibitors. In the EULAR 2022 guidelines, it says that avoid JAK inhibitors, particularly if a patient has cardiovascular risk or malignancy risk. Now, I personally don't agree with that and I personally will use a JAK inhibitor even if a patient is at increased risk, because if this is the best drug for them to control the disease then I will use it, acknowledging that there is a risk and acknowledging ways to reduce the risk. So even though the patient may have a risk factor for a heart attack, they have diabetes, they have high blood pressure, what I would say is that yes, I'm gonna try to use any therapies other than JAK first, like a TNF inhibitor or a non-TNF biologic, but if they've already failed that and their disease is active, their quality of life is poor, I'm gonna say, "Look, control your diabetes; exercise, lose weight. Control your blood pressure and then, you know, yes I'm gonna give you this medicine." But we'll monitor it, be aware of it; if you have chest pain or something, then let me know, let your primary care doctor know. So, where do I position JAK inhibitors with regards to the therapeutics that we have? I would say that if this is the best drug for them and if the insurance will pay for it and they can afford the medicine, I would still use it whether or not it's second line after methotrexate and conventional DMARDs or after TNF biologics. So, I think that JAK inhibitors are important part of our tools for rheumatologists. I don't know that the cardiovascular risk carries through all the JAK inhibitors, such as baricitinib or upadicitinib, because we really don't have the studies to support that these kind of events are associated with other JAK inhibitors as well.