Consensus Statement: Using JAK Inhibitors in Immune-Mediated Inflammatory Diseases

A multidisciplinary task force has developed a consensus statement on the use of Janus kinase (JAK) inhibitors for the treatment of immune-mediated inflammatory diseases (IMIDs). 

“Similar to the situation with [biological disease-modifying antirheumatic drugs (bDMARDs)] 15 [to] 20 years ago, real-world experience with JAK [inhibitors] is limited,” the authors wrote. “The task force set out to provide the readers with comprehensive guidance on the use of this novel class of targeted therapies regarding efficacy and safety, based on evidence and complemented by expert opinion. In this consensus statement, points to consider are provided for the use of JAK [inhibitors] across IMIDs for which they are approved or may be approved in the near future.”

Based on findings from a systematic literature review, the task force developed 4 general principles as well as 26 points for consideration. 

In part, the general principles highlight the importance of not only using shared decision-making with the patient when initiating and setting treatment targets of JAK inhibitor therapy, but also ensuring that the therapeutic approaches to treating patients with chronic inflammatory conditions adhere to international and national recommendations for the management of the respective disease. 

The 26 points of consideration included in the consensus statement were grouped into 6 areas: 

1. Indications
2. Treatment dose and comedication
3. Contraindications
4. Pretreatment screening and risks
5. Laboratory and clinical follow-up examinations
6. Adverse events

Some of the considerations included:

• No direct evidence has proven that any one JAK inhibitor is superior in efficacy or safety over another.
• Consider dose reduction of the JAK inhibitor among patients with rheumatoid arthritis in sustained Crohn’s Disease Activity Index (CDAI) or Boolean remission on background conventional synthetic DMARDs. 
• While rates of malignancy do not appear elevated with JAK inhibition, the risk of nonmelanoma skin cancer may be elevated.
• An annual skin examination should be performed.

“In summary, JAK [inhibitors] are a new class of agents for the treatment of a variety of IMIDs with efficacy in many indications that is at least as good as that of bDMARDs and with an acceptable safety profile,” the authors concluded. “Given their nonprotein nature, antidrug antibodies and thus a potential secondary loss of efficacy would not occur. It is anticipated that based on these qualities and on the fact that they can be taken by the oral route, their use will significantly increase over time.”

—Colleen Murphy

Reference:

Nash P, Kerschbaumer A, Dörner T, et al. Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a consensus statement. Ann Rheum Dis. Published online November 6, 2020. doi:10.1136/annrheumdis-2020-218398