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New indications for JAK inhibitors

There are several new positive RCTs for JAK inhibitors. We are so familiar with RA, PsA, SpA, axSpA and non radiographic axSpA.

Data are pending for phase 3 RCTs in SLE, with upadacitinib (30 mg/d) and deucravactinib (6mg bid) after positive phase 2 data.

And the list goes on!

A giant cell arteritis (GCA) late breaking abstract (LBA0001, EULAR 2024, Vienna) showed steroid sparing and efficacy of upadacitinib in this disease with data that seems very similar (to me) to tociluzimab in GCA.

There are positive studies for kids. Already tofacitinib and baricitinib had positive data in JIA and now upadacitinib also has enough data to receive FDA approval for JIA and juvenile PsA.

Moving beyond rheumatology

IBD has indications for JAKi use.

Tofacitinib was approved in ulcerative colitis (UC) but the primary endpoint was not met for Crohn’s disease (CD). Upadacitinib seems to work very quickly in both UC and CD with higher dosing than in rheumatology indications.

Atopic dermatitis (AD) has positive data with several JAKi. Topical JAKi with positive data in AD include:  delgocitinib, tofacitinib, ruxolitinib, cerdulatinib and ifidancitinib. Oral JAKi in this disease include upadacitinib, abrocitinib, and baricitinib with different approvals that are country dependent and doses.

Alopecia aerata (AA): Baricitinib 4mg od showed rapid improvement of AA and other JAKi are being studied in this area of unmet need.

Vitiligo: Topical and oral ruxolitinib have approval for vitiligo and litrecitinib, ritlecitinib and other JAKi are generating trial data.

So, in my opinion, with ongoing indications and studies in multiple diseases, the benefit outweighs the risk for JAKi in the treatment of patients with various chronic diseases.

References of interest

Mikhaylov D, et al. Oral JAK inhibitors for atopic dermatitis. Annals of Allergy, Asthma & Immunology. 2023:30:P577-592

Qi F, Liu F, Gao L. Janus Kinase Inhibitors in the Treatment of Vitiligo: A Review. Front Immunol 2021:12:790125


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