4.5 Review

Janus kinase-targeting therapies in rheumatology: a mechanisms-based approach

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Summary: Filgotinib, a Janus kinase inhibitor, has shown promise in treating patients with moderately-to-severely active rheumatoid arthritis in clinical studies. It received regulatory approval in Japan and Europe in 2020, though the US FDA requested additional data to assess its potential impact on sperm parameters. Expert opinions on the use of jakinibs for RA treatment will be provided based on basic research and clinical practice.

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Christoffer B. Nissen et al.

Summary: The COVID-19 pandemic has led to over 2 million deaths worldwide, with immune modulators and immunosuppressive drugs proposed as treatments. Further studies are needed to confirm the efficacy and safety, with potential for more clarity on the use of other anti-rheumatic drugs in the next 12 months.

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Bernard Combe et al.

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Summary: Upadacitinib showed significant improvement in remission and low disease activity rates in patients with RA compared to placebo, methotrexate, and adalimumab in five pivotal trials. However, there may be an increased risk of herpes zoster and creatine phosphokinase elevations when compared to methotrexate and adalimumab.

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Yusuke Miyazaki et al.

Summary: BARI demonstrated a similar safety profile and better clinical outcomes compared to TOFA after minimization of selection bias. However, these findings were based on a small population, suggesting the need for further investigation in a properly powered head-to-head trial.

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JAK selectivity and the implications for clinical inhibition of pharmacodynamic cytokine signalling by filgotinib, upadacitinib, tofacitinib and baricitinib

Paqui G. Traves et al.

Summary: JAKinibs, including filgotinib, show varying degrees of potency in inhibiting different JAK-dependent pathways in both healthy and RA blood. Filgotinib demonstrates the highest selectivity for JAK1 pathways compared to other JAKinibs, with less inhibition of JAK2-dependent and JAK3-dependent pathways. Ex vivo pharmacodynamic data from phase 1 healthy volunteers confirms the JAK1 selectivity of filgotinib.

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Atul Deodhar et al.

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Summary: This review evaluates the clinical trial data of Janus kinase inhibitors for psoriatic arthritis and spondyloarthritis, showing that these orally administered agents have different selectivity towards JAK1, JAK2, and JAK3, which may impact their efficacy and safety in PsA and SpA. Phase 2 and 3 trials have confirmed the efficacy of these inhibitors in PsA and SpA, with safety profiles comparable to those in rheumatoid arthritis studies.

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A phase 2a randomized, placebo-controlled study to evaluate the efficacy and safety of the oral Janus kinase inhibitors ritlecitinib and brepocitinib in alopecia areata: 24-week results

Brett King et al.

Summary: The study evaluated the efficacy and safety of two Janus kinase inhibitors, Ritlecitinib and Brepocitinib, in patients with alopecia areata, showing promising results in improving hair loss. However, two patients in the Brepocitinib group experienced serious adverse events.

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Iain B. McInnes et al.

Summary: In a phase 3 trial, both 15mg and 30mg upadacitinib had significantly higher ACR20 response rates at week 12 compared to placebo, with the 30mg dose being superior to adalimumab. Adverse events were more common with upadacitinib than with placebo.

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Clare Harris et al.

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Yoshiya Tanaka

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Stanley B. Cohen et al.

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Paul Emery et al.

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