Janus-kinase inhibitors in rheumatoid and psoriatic arthritis and other rheumatic disease

Janus kinase inhibitors suppress the activity of the intracellular JAK-STAT signalling pathway that mediates the effects of the multiple cytokines and growth factors, which play anessential role in the pathogenesis of rheumatic diseases. Unlike biologic agents, Janus kinase inhibitors can be administered orally and do not induce formation of neutralizing antibodies. In rheumatology, Janus kinase inhibitors can be used in combination with the standard disease-modifying antirheumatic drugs (DMARD) for the treatment of patients with rheumatoid arthritis (RA) who do not respond to DMARD or biologic agents. However, monotherapy with to facitinib orbaricitinib is also possible, if patients do not tolerate DMARD or have contraindications for their administration. In the ORAL Shift study, monotherapy with tofacitinib in RA patients who achieved low disease activity following combination treatment with tofacitinib and metothrexate was at leastas effective as combination treatment with two medications. Placebo controlled clinical trials showed the efficacy of tofacitinib in the treatment of psoriatic arthritis, psoriasis and inflammatory bowel diseases. Currently, the efficacy and safety of Janus kinase inhibitors are the subject of studies inpatients with ankylosing spondylitis and other inflammatory diseases.

Key words

Janus kinase inhibitors, tofacitinib, baricitinib,rheumatic diseases.