This year’s Great Debate during ACR Convergence 2020 focuses on when to use Janus kinase (JAK) inhibitors.
The Great Debate: Janus Kinase Inhibitors Should/Should Not Be Used Before Biologics After Methotrexate Failure in RA will take place Friday, Nov. 6. From 10 – 11 a.m. EST. This session will feature a live question-and-answer period at the end, and registered attendees can watch a replay of the debate on demand through Wednesday, March 11.
“JAK inhibitors are becoming a huge class, not just in rheumatology, but in dermatology and IBD, and other interferonopathies, and probably sarcoidosis along with many other diseases,” said Vibeke Strand, MD, adjunct clinical professor in the Division of Immunology, Stanford University School of Medicine. “They’re going to be really broadly used, so from that point of view, our experience in RA is very relevant.”
Dr. Strand will argue for using JAK inhibitors before biologics. Michael E. Weinblatt, MD, John R and Eileen K Riedman Professor of Medicine, Harvard Medical School, and R. Bruce and Joan M. Mickey Distinguished Chair in Rheumatology, Brigham and Women’s Hospital, will argue against their use before biologics.
The 2015 ACR guideline for the treatment of RA calls for using TNF inhibitors before JAK inhibitors when the patient doesn’t respond to DMARDs. But since the release of that guideline, additional data supports the case for using JAK inhibitors earlier, with many wondering if a change or update is needed.
Dr. Strand will present data showing that patient-reported outcomes for pain and global assessment improve faster for patients using JAK inhibitors before biologics—within two-and-a-half to three days—than patients taking biologics. Also, maximum response takes place at about three months, compared with six months for biologics.
“But the main argument, above probably anything, and why I’d like to use them earlier is that oral medications are so convenient,” Dr. Strand said. However, this also varies according to patient preferences.
Dr. Weinblatt said that he plans to highlight some of the efficacy and toxicity concerns, including worries about venous thromboembolic events and increases in herpes zoster. And TNF inhibitors appear to have a better record when it comes to pregnancy, with extended efforts to study their effects.
“Both are very effective in the management of RA,” Dr. Weinblatt said. “But while both classes of drugs work, they have different toxicity issues, and patient selection is important.”