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Should we be using JAKi more in female SpA patients?
In recent years, data has emerged suggesting that female patients with spondyloarthritis, both psoriatic arthritis and axial spondyloarthritis, may have worse outcomes than male patients. A number of post-hoc analyses of randomised controlled trials of both TNF inhibitors and IL-17 inhibitors suggest that this phenomenon is also manifested in the responses to these agents; female patients do less well than male patients. The mechanisms behind this remain to be fully elucidated.
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Rheumatoid arthritis and the ‘big bang’ at the ACR!
Is there ‘bang for the buck’ using big data to help predict who will develop RA in at-risk populations and similarly to predict response to csDMARDs, TNFi and JAKi in RA?
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Pre-ACR25 (10.24.2025)
Dr. Jack Cush reviews the news and info reports the day before ACR 2025
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#ACR25 Abstr#LB02 Is there a role for JAK-i for the treatment of IgG4-RD? Opel label RCT in China (N=58) showed NO relapse in Tofacitinib + GC taper vs GC Taper alone (54%). No serious infection. Interesting and a PBO-controlled is warranted @RheumNow https://t.co/dFvAmcGfCT
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
When every option fails, bold moves remain.
In 5 multi-resistant RA pts, TNFi + JAKi combo brought remission in most without major AEs.
Not standard, not risk-free, but in young, low-infection-risk pts, it may offer a path forward.
@RheumNow #ACR25 Abstract#2272
Jiha Lee JihaRheum ( View Tweet)
To be continued (or discontinued?): Abstract 2360: Compared to TNFi, IL-17i & JAKi users had 🔹 Higher odds of med switching <180 days 🔹 Shorter time to discontinuation @RheumNow #ACR25 #axSpA https://t.co/IOHaFSJqHn
Akhil Sood MD, MS AkhilSoodMD ( View Tweet)
SELECT-COMPARE RA UPA vs. ADA
What do we learn from 7 years data? Not much
Patients who did well on the first drug, keep doing well
Patients who required switching for primary failure don't do as well, w/ 26% pts reaching DAS remission in UPA + MTX vs. 16% in ADA + MTX gp
No https://t.co/JLUTRZuZOm
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
~1 in 6 pts with #sarcoidosis May have #cardiac involvemt
1/3 respond to #MTX + #steroids
Followed by repeat #PET
Failures get
👇
#infliximab >#adalimumab
👇
#JAKi
Better survival >yrs ago
R heart involved ⬆️risk of MTX nonresponse
#ACR25 @RheumNow @ACRheum abst#1664 #ACRbest https://t.co/kYt9JRNSVH
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Janet Pope Janetbirdope ( View Tweet)
SELECT-COMPARE (upadacitinib vs adallimumab in mod-severe RA, no CV enrichment) 7y data:
safety profiles very similar, except for:
- zoster
- CK rise
- lymphopenia
- hepatic disorder
In the general RA population, no new JAKi safety signals
#ACR25 ABST1676 @RheumNow https://t.co/BA2JxONGfa
David Liew drdavidliew ( View Tweet)
Infection data from SELECT-GCA:
Glucocorticoids seem to drive overall infectious risk
UPA use associated with higher zoster - vaccinate!!
@RheumNow #ACR25 Abst# 0895 https://t.co/ueVbFPxG0Q
Brian Jaros, MD Dr_Brian_MD ( View Tweet)
Avouac et al. Lipid changes after JAKi initiation. 85 patients. Increases at 6 months. Largely appeared driven by HDL increase, and correlated CRP decrease. Appeared transient with return to baseline with time. @RheumNow #ACR25 Abstr#1333 https://t.co/CQ6u3ck1Ch
Richard Conway RichardPAConway ( View Tweet)
POETYK-PsA 1 & 2 Phase 3 RCT TYK2i Deucravacitinib
Pooled analysis 640+pts PBO vs. 640+pts DEUCRA 6mg QD
MDA 12% vs 22%
All elements of MDA response sig different except for Leeds enthesitis index
DAPSA Remission 2% vs. 9%
PsARC 42% vs. 61%
PASDAS -1 vs. -1.7
mCPDAI -1.2 vs. -1.9 https://t.co/OTOFxTOrRp
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
Sex based differences in PsA proteomics
Analyse from POETYK PSA 1 & 2 deucravacitinib RCT
Large overlap but female pts specificities, Upregulation of:
-JAK STAT pathway
-Cytokine interaction
Linked with higher disease activity in female groups
Yes Correlation, but not https://t.co/VwiVOkxpoB
Links:
Aurelie Najm AurelieRheumo ( View Tweet)
#1627 SLR informing the 2025 @eular_org recommendations for PMR & LVV 🔍
141 studies (30 RCTs) reviewed: new & further evidence for IL-6, JAK & B-cell-targeted therapies. Data will underpin updated management guidance. @RheumNow #ACR25
Mrinalini Dey DrMiniDey ( View Tweet)
Real-world Indian cohort of 290 axSpA patients, generic tofacitinib achieved low/inactive disease in 89% after 25 months. Most adverse events were mild (e.g., transaminitis 14.5%) and manageable. No serious infections or MACE reported. A cost-effective alternative to bDMARDs in https://t.co/JBHfNq7kYt
Antoni Chan MD (Prof) synovialjoints ( View Tweet)
Real-world JAK persistence in RA is low: <30% at 2 years across Medicare & Marketscan data (n≈20K). Baricitinib lowest persistence; TOF & UPA slightly higher. Oral convenience hasn’t solved long-term adherence. Why? Safety, cost, access?
@RheumNow #ACR25 A#0369
Jiha Lee JihaRheum ( View Tweet)
#ACR25 Abstr#776 2-Year SELECT-GCA RCT showed that #GCA patients receiving continuous UPA15 to 2-yr maintained their remission (69%) vs those who switched to PBO after in remission for ≥24 weeks (29%). Lower serious infection but higher herpes zoster in UPA15. One VTE @RheumNow https://t.co/FCTNqCVxiZ
Links:
Md Yuzaiful Md Yusof Yuz6Yusof ( View Tweet)
Ramiro et al. No significant differences seen between men and women in response to upadacitinib in AxSpA at week 14 or 52. Differs from data on TNFi/IL17i in this regard. Looks to me like men respond a bit quicker and better though... @RheumNow #ACR25 Abstr#589 https://t.co/2m7mrgcG0z
Richard Conway RichardPAConway ( View Tweet)
DERM on RheumNow (October 2025)
Skin important Citations and Content curated for dermatologists – addressing Psoriasis, PsA, CLE, vasculitis, HS, other CTD skin disorders. dermatology drugs, biiologics, JAKs - their use, efficacy and side effects. Features Dr. Jack Cush, Editor https://t.co/bIK3e8sL45
Dr. John Cush RheumNow ( View Tweet)
Phase 3b/4 head-to-head SELECT-SWITCH study tested Humira vs Rinvoq in 492 RA MTX pts failing a TNFi then Rx w/ ADA vs UPA x12 wks. UPA > ADA w/ DAS28-CRP < 3.2 (43% vs 22%; p<0.001) and also for DAS28-CRP < 2.6 (28% vs 14%). No new safety signals seen.https://t.co/EAJ9GglMjv https://t.co/uHTsdTPpWP
Dr. John Cush RheumNow ( View Tweet)
