GCP - I agree w/ your wise views - but I would restate: these findings CONFIRM JAK inhibs do rais the risk of VTE. The current package insert for all these drugs state these JAKi should be used after TNFi.
But students who have studied both the oral surveillance study and this study have discerned that the risks are not uniform for all RA, PsA, etc pts. The risk is higher w/ VTE risks, Elderly >65, smokers with the cardiac event in the past. With those filters, the prohibition of JAKi is much smaller than originally thought. The current study was a direct comparison of baricitinib and TNFi and failed to show an increased risk of MACE and malignancy comparing therapies. Looking ahead -- you wont get any better data than these two 4+ year studies with over 8000 patients in a blinded randomized trial of two classes. Yet many will try to re-created Oral Surveillance like data from cohorts, registries, claims data, EHR, etc -- those weaker attempts are not DBRPCTs and thus should never be compared. Thats not just my opinion, its what FDA, EMA and epidemiologists would best rely on.