Which is the role of janus kinase inhibitors (JAKi) in the treatment of rheumatic diseases?

Janus Kinase inhibitors (JAK inhibitors or JAKi) play a significant role in the treatment of various rheumatic diseases by targeting the Janus Kinase (JAK) pathway. The JAK-STAT signaling pathway is crucial for the transmission of signals from cytokines and growth factors involved in immune responses and inflammation. JAK inhibitors interfere with this pathway, modulating the immune system and reducing inflammation.

  • Tofacitinib: Tofacitinib was the first JAK inhibitor approved for the treatment of moderate to severe rheumatoid arthritis and active psoriatic arthritis in adults who have had an inadequate response or intolerance to methotrexate. It inhibits JAK1 and JAK3.
  • Baricitinib: Baricitinib is another JAK inhibitor approved for rheumatoid arthritis and psoriatic arthritis. It primarily inhibits JAK1 and JAK2. Baricitinib can be used alone or in combination with methotrexate.
  • Upadacitinib: Upadacitinib is a JAK inhibitor that selectively inhibits JAK1. It has been approved for the treatment of moderate to severe rheumatoid arthritis. Studies are ongoing to assess its efficacy in other rheumatic diseases.
  • Filgotinib: Filgotinib is another JAK inhibitor with specificity for JAK1.It has been approved for the treatment of moderate to severe rheumatoid arthritis and is being investigated for other inflammatory conditions.

JAK inhibitors are considered when other treatments, such as conventional synthetic DMARDs or biologics, are not suitable or effective. They are oral medications, providing an alternative to injectable therapies.