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Playing it Safe with RA? JAK vs. TNF Debate
Reported safety signals, at odds with the efficacy of these medications, have left rheumatology clinicians in a difficult position when considering when during a patient’s treatment course and in which patients, specifically, JAKi should be used. Two abstracts from ACR convergence 2024 further contribute to our understanding of this potential risk profile.
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JAKs and Other Drugs in PMR
This has been an interesting ACR meeting in terms of PMR updates. I would argue that we are still far too wedded to glucocorticoids only in the management of PMR. Yes, some patients will do fine with just glucocorticoids but we persist far too long with a glucocorticoid only strategy in others who clearly need an alternative as glucocorticoid adverse events multiply.
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ORAL Surveillance - Is Statin Use the Problem/Solution?
The findings from ORAL Surveillance Study have been a dominant conversation at recent ACR Convergence, with the seminal findings and subsequent analyses a target of debate. Subsequent post-hoc analyses, follow-up studies, and claims data analyses have been used to further interpret the data, though a clear answer on safety is not certain. A study presented on Sunday reported on a new post-hoc analysis that provides new insights.
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ACR 2024: What Exactly do JAKs and TYKs Do?
Let me start by confessing something embarrassing: the immune system is just too complex for me to understand. I suspect the onslaught of new drugs with new mechanisms at ACR 2024 may have left many of you feeling similarly. This may be particularly true for the TYK/JAK/STAT signaling pathway, where each agent has a slightly-different combination of binding affinity to various JAK and TYK signaling dimers. In this article I want to share some diagrams from ACR 2024 that may help.
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RA: One JAK to Rule Them All? Dr. Brian Jaros reports on abstract 1362, presented at #ACR24. https://t.co/QChMyma3Y2 https://t.co/qq3BqpT2Gh
JAKi in inflammatory myositis? #ACR24 will showcase nearly 3000 abstracts. With the expanding use of JAK inhibitors, there will be some interesting presentations for off label use. There have been some uncontrolled data that tofacitinib reduced inflammatory myositis disease… https://t.co/SnqvElwk0B https://t.co/A5mJbpmB5P
Janet Pope Janetbirdope ( View Tweet)
Richard Conway RichardPAConway ( View Tweet)
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Selective TYK2i zasocitinib, results of Phase 2 DBRCT Dose dependent improvements in various PsA outcomes; NNT~5 for DAS28 remission, NNT~20 for PASDAS Hard to compare to current agents, somewhere between JAKs (woot!) & "apremlist zone" 🫣 #ACR24 @RheumNow Abstr#2584 #ACRbest https://t.co/t0y6C618ll
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Always looking for cancer/CV signals from JAKi in big observational datasets w extensive JAKi use nationwide 🇯🇵 claims data RA pts n=52k (JAKi n=4.3k) Cancer with JAKi vs TNFi: aHR 2.2 (esp lung, lymphoma) This is a problem. Watch these data. #ACR24 ABST1336 @RheumNow #ACRBest https://t.co/vsnT46De6T
