How to Use Janus Kinase Inhibitors in the Treatment of Rheumatoid Arthritis? A Clinical Assessment of Risks and Benefits

IF 5.7 2区医学 Q1 RHEUMATOLOGY Current Rheumatology Reports Pub Date : 2023-12-16 DOI:10.1007/s11926-023-01122-9

Fatima K. Alduraibi, Jasvinder A. Singh

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Abstract

Purpose of Review

To provide an updated understanding of risks and benefits of Janus kinase inhibitors (JAKi) versus biologic disease-modifying antirheumatic drugs (bDMARDs) in the management of rheumatoid arthritis (RA).

Recent Findings

Shared decision-making is needed in choosing between JAKi and bDMARDs. Cardiovascular disease, malignancy, and thromboembolic events guide this choice. In patients with active RA despite methotrexate use, tumor necrosis factor inhibitor is conditionally favored over JAKi for low-cardiovascular-risk patients and strongly favored in those with pre-existing cardiovascular disease or multiple cardiovascular risk factors. Suboptimal treatment of treatment-refractory RA patients may pose a greater absolute cardiovascular risk than with JAKi use. Use of aspirin and statin may be considered to reduce cardiovascular risk.

Summary

New safety data on JAKi has redefined the treatment approach in RA. JAKi remains an important oral medication option in active RA despite treatment with bDMARDs, especially in those with low cardiovascular risk.

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如何使用 Janus 激酶抑制剂治疗类风湿关节炎？风险与益处的临床评估

最新研究结果在选择 JAKi 和 bDMARDs 时需要共同决策。心血管疾病、恶性肿瘤和血栓栓塞事件是选择的指导因素。在使用甲氨蝶呤的活动性RA患者中，对于心血管风险较低的患者，肿瘤坏死因子抑制剂有条件地优于JAKi，而对于已有心血管疾病或存在多种心血管风险因素的患者，肿瘤坏死因子抑制剂则更受青睐。与使用JAKi相比，对难治性RA患者进行次优治疗可能会带来更大的绝对心血管风险。可考虑使用阿司匹林和他汀类药物来降低心血管风险。总结 JAKi 的新安全性数据重新定义了 RA 的治疗方法。尽管使用了bDMARDs治疗，JAKi仍然是活动性RA患者的重要口服药物选择，尤其是对于心血管风险较低的患者。

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来源期刊

Current Rheumatology Reports RHEUMATOLOGY-

CiteScore

11.20

自引率

0.00%

发文量

期刊介绍： This journal aims to review the most important, recently published research in the field of rheumatology. By providing clear, insightful, balanced contributions by international experts, the journal intends to serve all those involved in the care and prevention of rheumatologic conditions. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas such as the many forms of arthritis, osteoporosis and metabolic bone disease, and systemic lupus erythematosus. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also occasionally provided.