JOURNAL ARTICLE

Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a consensus statement

Peter Nash, Andreas Kerschbaumer, Thomas Dörner, Maxime Dougados, Roy M Fleischmann, Klaus Geissler, Iain McInnes, Janet E Pope, Désirée van der Heijde, Michaela Stoffer-Marx, Tsutomu Takeuchi, Michael Trauner, Kevin L Winthrop, Maarten de Wit, Daniel Aletaha, Xenofon Baraliakos, Wolf-Henning Boehncke, Paul Emery, John D Isaacs, Joel Kremer, Eun Bong Lee, Walter P Maksymowych, Marieke Voshaar, Lai-Shan Tam, Yoshiya Tanaka, Filip van den Bosch, René Westhovens, Ricardo Xavier, Josef S Smolen
Annals of the Rheumatic Diseases 2021, 80 (1): 71-87
33158881

OBJECTIVES: Janus kinase inhibitors (JAKi) have been approved for use in various immune-mediated inflammatory diseases. With five agents licensed, it was timely to summarise the current understanding of JAKi use based on a systematic literature review (SLR) on efficacy and safety.

METHODS: Existing data were evaluated by a steering committee and subsequently reviewed by a 29 person expert committee leading to the formulation of a consensus statement that may assist the clinicians, patients and other stakeholders once the decision is made to commence a JAKi. The committee included patients, rheumatologists, a gastroenterologist, a haematologist, a dermatologist, an infectious disease specialist and a health professional. The SLR informed the Task Force on controlled and open clinical trials, registry data, phase 4 trials and meta-analyses. In addition, approval of new compounds by, and warnings from regulators that were issued after the end of the SLR search date were taken into consideration.

RESULTS: The Task Force agreed on and developed four general principles and a total of 26 points for consideration which were grouped into six areas addressing indications, treatment dose and comedication, contraindications, pretreatment screening and risks, laboratory and clinical follow-up examinations, and adverse events. Levels of evidence and strengths of recommendations were determined based on the SLR and levels of agreement were voted on for every point, reaching a range between 8.8 and 9.9 on a 10-point scale.

CONCLUSION: The consensus provides an assessment of evidence for efficacy and safety of an important therapeutic class with guidance on issues of practical management.

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Christoph Haller

ARR review. JAKs.
JAKs gegeneinander keine Superiority (aber Studien gibt's H2H dicit ARR)
Reduktion bei Remission
Wenn OAK > kein Problem JAK geben

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