VIDEO: JAK inhibitors' impact on the treatment landscape of psoriatic arthritis

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 editor@healio.com if there are concerns regarding accuracy of the transcription.

I think, yes, of course. Patients with psoriatic arthritis, as all of us can attest, can have very aggressive phenotypes. There are subsets of patients who get very aggressive disease from the start, joints damage. So we do find ourselves getting to the end of the line. And then what medication do we do next? We are starting to cycle more rapidly through mechanisms. Typically, we won't exhaust every single medication in a certain mechanism of action type of bucket and then going straight line. We'll try to change the mechanism. So I think here is where JAK inhibitors provide an additional option. Unfortunately, with the safety data and with the new FDA recommendation, I think, the impact has decreased because they are to be used in people who didn't tolerate or who failed TNF inhibitors. So it's not, it's a little bit in the back of the shelf. So we still have to operate with slightly fewer mechanisms of action than if safety was much more comparable. Do you find this is the same thing in RA, doctor?

- So I would agree with you on that, Dr. Orbai. I think what I would probably add is that you have not only a new mechanism of action, but an oral option for a medication for your patients with psoriatic arthritis, which is new for them. Now, let's talk about the safety data of the JAK inhibitors. And since September of 2021, of course, FDA changed it's black box warning. In the rheumatoid arthritis world where we have been using these medications for the last five years or so, I think, there was always some sense of the fact that the JAK inhibitors, even though they're powerful and amazing medications to use in our patients, they may have side effects that are somewhat different in terms of their safety compared to the other biologics that we use in rheumatoid arthritis.

As a rheumatologist, I feel thrilled that we now actually have data that helps us sit down with our patients and make a shared decision with them so that we can put all the cards on the table. And we can talk to them about how while these are very powerful medications. And we are going to use them when we come to that point of needing to use these medications. But what are the concerns that we have as physicians? And how patient education and a shared decision-making model becomes very critical in use of these medications. So I honestly feel that the new data for us as physicians is empowering because we actually have numbers. And we can sit down with our patients and give them a sense of what is the increased risk of thromboembolic disease if you have these certain baseline comorbidities. And if we start you on a JAK inhibitor versus other medications, like as you said an anti-TNF agent. So yes, Dr. Orbai, I would say that it's a good addition to your world in psoriatic arthritis. And in my world, mostly taking care of patients with rheumatoid arthritis, I think it just gives me another powerful way of sitting down with my patients. And making them understand that if we choose to take these medications, this is some of the risks that we are taking. However, as I said, for so many of these patients as you had mentioned Dr. Orbai, they have cycled through so many different medications and they are not doing well. So this remains a very important and powerful tool for us, the JAK inhibitors. But again as I said, with appropriate attention to the safety data.