According to a new studio, the new oral drugs forrheumatoid arthritis (RA) work quite well in the “real world”, despite some doubts as to whether they would work.
The results of research were published in the scientific journal Rheumatology.
Rheumatoid arthritis: here are all the therapeutic news
The study, conducted on 622 adults suffering from rheumatoid arthritisfound that most did well on drugs called JAK inhibitors, a relatively new class of drugs for the arthritic condition.
They are taken orally, unlike many other rheumatoid arthritis drugs, which are given via injection or infusion. are approved in the United States. They are specifically for people with rheumatoid arthritis who do not get relief or cannot tolerate older rheumatoid arthritis medications.
But while the JAK inhibitors have been shown to be effective in clinical trials, there have been questions about whether this can translate into the real world, where they are often given to patients whose rheumatoid arthritis has stubbornly resisted standard treatment.
THE Japanese researchers found that patients taking any of the four JAK inhibitors approved in the country generally fared well.
Overall, about a third saw remission of rheumatoid arthritis within six months and over 80% achieved the “low disease activity” goal, where symptoms are largely under control.
The conclusion is simple, according to a US rheumatologist not involved in the research: “This study confirms the effectiveness of JAK inhibitor therapies,” said Dr. Stanley Cohen, of Rheumatology Associates in Dallas.
This also suggests that the different JAK drugs are equally likely to work, he said Cohen. No studies have compared the drugs head-to-head, he noted, but individual studies of each drug have suggested that they have the same effectiveness, and “real-world experiences,” including the new study, bear this out, Cohen said.
Rheumatoid arthritis is caused by incorrect attachment of the immune system to the joint tissue of the body, which causes pain, swelling and stiffness in the joints. Over time, systemic inflammation can fuel problems in other areas of the body, including the heart, lungs, skin and eyes.
Numerous rheumatoid arthritis drugs can slow the progression of joint damage by targeting parts of the immune response. The inhibitors JAK I am among them. However, they are not considered a starting choice for RACohen said.
The expert pointed to a 2021 study that raised concerns about the safety of JAK inhibitors for some older patients.
The study included patients with rheumatoid arthritis aged 50 or older who had at least one risk factor for heart disease or stroke, such as high blood pressure or diabetes. It turned out that those who had been given the inhibitor JAK tofacitinib had a higher risk of heart attack, stroke and some cancers, compared to patients who were given a TNF blocker.
TNF blockers are drugs antiretrovirals older ones, given by injection or infusion, which include etanercept (Enbrel) and adalimumab (Humira).
Based on these results, the US Food and Drug Administration added a warning in a box to all JAK inhibitors used for rheumatoid arthritis. The agency also recommended that doctors prescribe a JAK inhibitor only after patients have tried at least one TNF inhibitor.
For the new study, researchers led by Dr Shinya Hayashi of theKobe University in Japanand analyzed the medical records of 622 rheumatoid arthritis patients treated at seven medical centers. All received any of the four JAK inhibitors approved in Japan.
The researchers found that most patients, about 90%, were still taking the drugs six months after starting. AND most had achieved relief of symptoms, or even remission.
This isn’t the end of the story, though. Six months is a short follow-up, the researchers pointed out, and it’s unclear how effective JAK inhibitors are long-term.
In addition to effectiveness, people with rheumatoid arthritis must also consider the safety of the treatment. Cohen noted that although JAK inhibitors have been linked to some greater risks than TNF inhibitors, the overall risks still appear “pretty low.”
In the study that gave rise to the FDA warning, 3.4% of patients treated with tofacitinib had a heart attack or stroke within four years, compared to 2.5% of TNF inhibitor users.
Overall, Cohen said, the risks of JAK inhibitors appear similar to those of TNF blockers and other “biologic” drugs that target theunderlying immune activity that drives rheumatoid arthritis. Because they curb part of the immune response, all of these drugs can make people more susceptible to certain infections.
Cohen said JAK inhibitors appear to pose a greater risk of shingles, which is caused by a reactivation of the chickenpox virus (which, after a person is infected, remains dormant in the body). But this, Cohen noted, can be counteracted with shingles vaccination.
The study received no external funding. Some of the co-researchers of Hayashi they received funding from the pharmaceutical companies that make JAK inhibitors.
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