Use of JAK Inhibitors in RA-ILD

Hello, my name is Elena Jurns and I'm reporting from Orlando, Florida. A lot of interest in JAK inhibitors in RA-ILD at this meeting. I'm glad to see the studies because we certainly need more. It does seem that JAK inhibitors are helpful in our RA-ILD based on a small meta-analysis which was published in 2024. But we have so many JAK inhibitors now and we are often limited by insurance companies and what we can prescribe. But are they truly interchangeable? Are they truly safe and efficacious in our reality?

Well, this meeting had several relevant posters. Poster number 0478 by Dr. Munos detailed results of a retrospective observational study of baricitinib in 84 patients with RA-ILD. They demonstrated stability of PFTs and improvement in dyspnea throughout follow-up. And importantly, the steroid use was decreased. We of course don't know how their trajectory was prior to the treatment from the abstract, but the improvement in symptoms and reduction in steroids is encouraging regardless.

Poster number 0449 by Dr. Kikuchi and colleagues also demonstrated that the RA-ILD was stable and even improved based on lung ultrasound scores with treatment with JAK inhibitors. They didn't specify the JAK inhibitors unfortunately.

In poster 0703, Dr. Ortiz and colleagues looked at 43 patients from Spain treated with upadacitinib and found stability or improvement in lung function parameters and again symptoms of dyspnea.

Despite these promising results, JAK inhibitors are still not widely used in RA-ILD, as per poster number 0462 by Dr. Serento Monroy regarding real-world treatment patterns in RA-ILD. Their nested case-control study from Spain showed that only 3% of patients with RA-ILD were treated with JAK inhibitors, but 11% of patients with RA with no ILD at baseline were treated with JAK inhibitors.

Important safety signals for JAK inhibitors were also assessed. I think the worry about cardiovascular safety precludes us often from prescribing JAK inhibitors in RA-ILD, as these patients are frequently those with many cardiovascular risk factors. Poster number 0441 by Dr. Kaiser compared safety between JAK inhibitors and found that tofacitinib was associated with significantly higher risk compared to baricitinib in terms of major cardiovascular events. And Dr. Kaiser's study in poster 0442 found that signal as well — tofacitinib but not upadacitinib was associated with higher risk of major cardiovascular events in a real-world study.

The multitude of studies of JAK inhibitors — and these are not even all the posters about them — support the use of JAK inhibitors in RA-ILD. Safety signals support going for baricitinib or upadacitinib in patients with RA-ILD who have cardiovascular risk factors, and I would advocate for perhaps a randomized controlled trial specifically in RA-ILD using specific JAK inhibitors. It does seem like we're not using JAK inhibitors enough in our ILD yet, but hopefully that will change with more data. Thank you.