Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a systematic literature research

RMD Open 2020;6:e001374 doi:10.1136/rmdopen-2020-001374

Trials of JAKi have been conducted in many therapy areas, including rheumatology, dermatology and gastroenterology. In 2019, a task force was set up to create a consensus to guide clinicians on how to use JAKi in clinical practice. This systematic literature review conducted in 2019 support this consensusIn line with EULAR’s standardised operating procedures for recommendations, a literature search was conducted in EMBASE, Medline and the Cochrane Library databases. To evaluate the efficacy of the various JAKi agents, only double-blind RCTs were considered. For the safety evaluation, cross-sectional, cohort and case-control studies were also eligible. In total, 3,454 studies were screened, and a final 85 publications evaluated in detail. Efficacy of JAK inhibition was shown for several pan-JAKi as well as JAK-selective compounds, with variable results across immune-mediated inflammatory diseases. The area with the most evidence is rheumatoid arthritis, followed by IBD and psoriasis. To date, there is limited evidence in other diseases. JAKi show an acceptable safety profile in investigated populations, although there is an increased risk of infection – especially herpes zoster and serious infection – and numerically higher rates of VTE. Liver enzymes and creatine kinase elevations as well as lymphopenia and leucopenia appeared more frequently during JAKi treatment. Additional data are required to support the utility of JAKi across immune-mediated inflammatory diseases.