Rheumatoid arthritis: JAK inhibitors are effective for treating RA

• Researchers compared the efficacy and safety of four JAK inhibitors, a medication used to treat rheumatoid arthritis (RA).
• According to the researchers, no significant differences in efficacy or safety were observed between the four medications.
• Over 85% of participants remained on the medication during the six-month trial.

Rheumatoid arthritis is an autoimmune and inflammatory disease, according to the Centers for Disease Control and Prevention (CDC). Immune cells attack healthy tissue by mistake, usually in the joint’s lining, causing inflammation.

Typically, joints in the hands, wrists, and knees are affected. It can cause chronic pain, instability, and deformity. RA can also affect organs like the lungs, heart, and eyes.

Available biological disease-modifying medications (bDMARDs) effectively reduce disease activity and achieve remission. However, patients receive these via IV or subcutaneous injection.

JAK inhibitors are another type of RA medication that can be taken orally. They can also delay the progression of the disease.

Typically, treatment for RA starts with conventional DMARDs. If the response is not satisfactory, bDMARDs or JAK inhibitors might be recommended, according to a 2022 review.

These medications are more specific at targeting inflammatory markers and more efficient at inducing remission and low disease activity.

In a new study published on November 1 in Rheumatology, researchers in Japan completed a retrospective study comparing the efficacy and safety of four JAK inhibitors for treating rheumatoid arthritis (RA):

• tofacitinib (TOFA)
• baricitinib (BARI)
• peficitinib (PEF)
• upadacitinib (UPA)

The researchers determined no significant difference in efficacy or safety between the four JAK inhibitors they evaluated.

Study co-author Dr. Shinya Hayashi of the Department of Orthopedic Surgery at Kobe University Graduate School of Medicine, Japan, told Medical News Today:

“Several papers demonstrated the efficacy and safety of difference among JAK inhibitors,” However, those reports did not adjust patients’ backgrounds. We first compared the efficacy of JAK inhibitors after patients background matching. The efficacy and safety of TOF, BAR, PEF, and UPA were not significantly different for the treatment of RA patients.”

What do JAK inhibitors do for rheumatoid arthritis?

There were 622 patients treated at seven major university hospitals in Japan. They were treated with JAK inhibitors and monitored for side effects, disease improvement, and whether they wanted to continue taking the medications.

The researchers used the Clinical Disease Activity Index, C-reactive protein value, and modified Health Assessment Questionnaire to measure the effectiveness of the medications after six months of use.

According to a media release, the researchers found that roughly 1 in 3 RA patients reached remission, with 3 in 4 reaching low disease activity.

The researchers noted that after six months, over 80% of the subjects were still on JAK inhibitor drugs. Retention rates over six months included:

• Overall – 85.4%
• TOFA – 87.4%
• BARI – 89.5%
• PEF – 82.8%
• UPA – 83%.

“Medical professionals can feel comfortable choosing JAK inhibitors if a patient failed bDMARD treatment,” Dr. Hayashi noted.

What are the side effects of JAK inhibitors?

A small number of adverse events among patients using JAK inhibitors to treat RA were reported.

To that end, the FDA’s black box warning on JAK inhibitors indicates several health risks, including an increased risk of cardiovascular events. These include:

• bacterial, viral, and fungal infections
• opportunistic infections, such as tuberculosis
• higher rate of lymphoma, lung cancer, thrombosis, pulmonary embolism, venous, and arterial thrombosis

Individual JAK inhibitors could have additional side effects.

More research in the broader RA population needed

Although the study had some notable strengths, such as using real-world settings rather than controlled trials to determine the effectiveness and safety of JAK inhibitors, it did have some limitations.

First, the researchers did not closely examine the link between side effects and discontinuation of the medication.

In addition, due to the small number of participants, the researchers could not generalize the results to the larger RA population.

The observational duration was only 24 weeks, and more studies with longer durations are needed.

Lastly, the scientists did not monitor changes in dosage during the study period.

What lifestyle changes can help with rheumatoid arthritis?

Chronic pain associated with RA can affect people in many ways — personally, socially, and economically.

According to a 2022 report, certain lifestyle factors are associated with chronic pain severity, such as:

• physical inactivity
• stress
• poor sleep
• unhealthy diet
• smoking

Dr. Klee Bethel, director of Interventional Pain Management and Regenerative Medicine at Sonoran University, told MNT that gentle exercises best suit people with RA.

Dr. Bethel recommended the following gentle exercises for RA:

• walking
• dancing
• yoga
• tai chi

If you live with RA and experience discomfort with any form of movement, ask your doctor for guidance about exercises that best suit your needs.

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