Janus kinase inhibitors (JAKis) are an important treatment option for people with chronic inflammatory diseases such as rheumatoid arthritis, psoriasis, Crohn's disease or ulcerative colitis. Since their approval, the indications for these medical drugs have steadily increased, but recently safety concerns have also been raised. In order to support the safe and efficient use of JAK inhibitors in the treatment of patients, an international panel of experts led by MedUni Vienna has published new guidelines. The consensus statement was recently published in the renowned journal Annals of the Rheumatic Diseases.
In order to address the increasing complexity of the use of JAK inhibitors, an international working group led by Josef Smolen (MedUni Vienna's Department of Medicine III) has updated the 2019 guidelines in line with the latest scientific findings. The team also took into account safety issues raised in recent studies regarding a possible increased risk of cardiovascular disease and cancer in connection with taking these medications. "Our multidisciplinary working group was made up of clinicians with expertise in JAKi therapy, other healthcare professionals and patients who have experience with these drugs," reports Josef Smolen. The topics discussed included indications, dosage and co-medication strategies, warnings and contraindications, monitoring recommendations and side effect profiles.
The new consensus statement emphasises that the use of JAKi should always be based on an individual risk-benefit assessment in shared decision with the patient. In doing so, safety issues, including indications of a possibly increased risk of cardiovascular diseases and certain types of cancer, must be carefully considered. Important new aspects also include more precise recommendations for dosage, which should be adjusted according to age, kidney and liver function, and accompanying risk factors. In addition, specific precautions for infection prevention, such as vaccination strategies, are emphasised.
JAK inhibitors were first approved in the United States in 2012 for the treatment of rheumatoid arthritis, with Austria following suit in 2017. Because these drugs specifically block cellular signalling pathways that are responsible for maintaining inflammatory responses, JAKi have been researched and approved over the years for the treatment of other immune-mediated inflammatory diseases. The drugs are now an important treatment option for patients with psoriasis, atopic dermatitis, Crohn's disease, ulcerative colitis and many other chronic inflammatory diseases for which other treatments are ineffective or are not tolerated. Accordingly, in addition to international experts, the expertise of several departments at MedUni Vienna, such as Daniel Aletaha, Andreas Kerschbaumer and Viktoria Konzett (all Rheumatology), Michael Trauner (Gastroenterology), Maria Krauth (Haematology) and Markus Zeitlinger (Clinical Pharmacology), contributed significantly to the development of the consensus statement. The updated guidelines take into account the increasing importance of this treatment option: "Janus kinase inhibitors are highly effective drugs that offer hope to many patients. Our consensus statement is inteded to support their safe and effective use," Smolen says.
