Rheumatology Department, THR Presbyterian Hospital.
Rheumatology Associates.
Curr Opin Rheumatol. 2021 May 1;33(3):300-306. doi: 10.1097/BOR.0000000000000792.
To review recently published articles on use of Janus Kinase inhibitors (Jaki) in the clinic for rheumatoid arthritis (RA).
Several Jaki have been approved for RA patients failing csDMARDS. Over the last 2 years, EULAR and ACR have published updated recommendations for the pharmacologic management of RA providing guidance on the utilization of Jaki after csDMARD failure. Clinical trials have been published addressing the efficacy of Jaki monotherapy as patients often choose monotherapy because of a desire to avoid multiple therapies and aggravating adverse events with csDMARDs. Previous clinical trials have compared the efficacy and safety of Jaki to adalimumab, and a trial comparing abatacept to upadacitinib has recently been published. An increased risk of venous thromboembolism (VTE) has been suggested with Jaki and additional information has recently become available with conflicting results.
Jaki are now standard therapy for RA patients failing csDMARDs and are being utilized frequently as an alternative to biologics in patients without risk factors for VTE. Jaki monotherapy has been demonstrated to be effective, although combination therapy has been demonstrated to be superior in clinical and radiographic outcomes. Preliminary data suggests that cycling through Jaki in patients with incomplete response to initial Jaki treatment may be an appropriate strategy.
回顾最近发表的关于 Janus 激酶抑制剂（Jaki）在类风湿关节炎（RA）临床应用的文章。
已有几种 Jaki 被批准用于治疗对 csDMARD 反应不佳的 RA 患者。在过去的 2 年中，EULAR 和 ACR 发布了 RA 药物治疗的更新建议，为 csDMARD 失败后 Jaki 的应用提供了指导。发表了一些临床试验，探讨了 Jaki 单药治疗的疗效，因为患者通常选择单药治疗，是因为希望避免多种疗法，并避免 csDMARD 引起的不良事件加重。先前的临床试验比较了 Jaki 与阿达木单抗的疗效和安全性，最近发表了一项比较阿巴西普与 upadacitinib 的试验。有研究提示 Jaki 会增加静脉血栓栓塞（VTE）的风险，最近有更多相关信息，但结果相互矛盾。
Jaki 现在是 csDMARD 治疗失败的 RA 患者的标准治疗方法，并且由于没有 VTE 风险因素的患者，Jaki 也常被用作生物制剂的替代药物。Jaki 单药治疗已被证明是有效的，尽管联合治疗在临床和影像学结果方面更具优势。初步数据表明，对于初始 Jaki 治疗反应不完全的患者，循环使用 Jaki 可能是一种合适的策略。
