Current jakinibs for the treatment of rheumatoid arthritis: a systematic review

Objective One-third of patients with severe rheumatoid arthritis (RA) do not achieve remission or low disease activity, or they have side effects from cDMARD and bDMARD. They will need a new treatment option such as the small molecule JAK inhibitors. In this systematic review, we evaluate the efficacy and safety data of the current jakinibs: tofacitinib, peficitinib, decernotinib, upadacitinib, baricitinib and filgotinib in patients in whom treatment with conventional or biological disease-modifying antirheumatic drugs (cDMARD and/or bDMARD) failed. Methods We searched for randomized controlled trials comparing efficacy and safety of jakinibs for RA treatment using the Web of Science, Scopus, PubMed, and clinicaltrials.gov databases with the terms: rheumatoid arthritis OR arthritis rheumatoid OR RA AND inhibitor OR jak inhibitor AND clinical trial OR treatment OR therapy. Results All jakinibs achieved good results in ACR 20, 50, 70 and with CRP-DAS28 for LDA and remission, upadacitinib showed better results compared to the others. In ESR-DAS28 for remission, tofacitinib achieved the best result. Regarding the safety of all jakinibs, peficitinib, baricitinib and filgotinib did not register deaths in their studies unlike tofacitinib that presented 11 deaths. Despite all benefits of jakinibs, the use in patients with severe liver and kidney disease should be avoided. Conclusions Jakinibs in monotherapy or in combination with methotrexate can be considered a viable alternative in the treatment of moderate-to-severe RA. Even after failures with combination of cDMARDS and bDMARDS, jakinibs demonstrated efficacy.

Automated summary

Jakinibs, including tofacitinib, peficitinib, decernotinib, upadacitinib, baricitinib, and filgotinib, have shown good results in achieving low disease activity and remission in patients with severe RA. Upadacitinib showed the best results among all jakinibs, while tofacitinib showed the best result in achieving remission. However, some jakinibs such as peficitinib, baricitinib, and filgotinib had no reported deaths in their studies, unlike tofacitinib which had 11 deaths. Despite the benefits, caution should be taken when using jakinibs in patients with severe liver and kidney disease.