Expanding JAK Inhibitor Market for RA on the Horizon in 2019: "Which One Is the Best?"

Expanding JAK Inhibitor Market for RA on the Horizon in 2019: Posted By:
...

Rheumatoid arthritis (RA) treatments continue to improve outcomes in the latest clinical trials. At the 2018 American College of Rheumatology (ACR) meeting there were five new phase III randomized controlled trials with Janus kinase inhibitors (JAKi) for two different drugs-upadacitinib and peficitinib. Should they receive US Food and Drug Administration approval, upadacitinib and peficitinib will be added to the already-marketed tofacitinib and baricitinib collection of JAKis.

For example, superior efficacy and acceptable side effect profiles were shown with upadacitinib in the SELECT-COMPARE trial as it was compared to the TNF inhibitor adalimumab. The ACR 20 score achieved with upadacitinib surpassed that of adalimumab at week 12—70.5% and 63%, respectively 36.4% placebo. Additionally, the ACR 70 score, considered by some to indicate remission (roughly 70% improvement in multiple parameters), was doubled in the upadacitinib group when compare to adalimumab.

Methotrexate was the background drug in SELECT-COMPARE, as it was in other JAKi trials, and it continues to be the anchor drug for most patients with RA.

"So which one is the best?" was the question asked by audience members at the meeting. The new JAKis mirror the two that are presently on the market, and there is no head-to-head comparison. Therefore, Josef S. Smolen, one of the presenters and chairman of rheumatology at Vienna University, stated, "I always wondered which beta-blocker to use, and I always wondered which cholesterol-lowering drug to use, and which NSAID to use. Interestingly enough, one NSAID will work in you but not me, and another will work in me and not in you. So I think we should be pleased that we will likely have several oral JAKis to choose from."

"Which one is best" is almost always a question of access. Access means negotiations by benefit managers and medical insurance companies. Long past are the days when rheumatologists could choose which specific drug is best for our patient, and this is one of the major changes in care I have witnessed over the past 39 years. Whoops, I guess I really am dating myself.

Nonetheless, drug research continues to improve outcomes for our patients with RA, and this is particularly relevant for me, as someone who used injectable gold salts in the 1980's along with high-dose aspirin! We truly have come a long way.

References
  • Jancin B. Jakinib explosion for RA: where do they fit in clinical practice? www.mdedge.com/rheumatology/article/191771/rheumatoid-arthritis/jakinib-explosion-ra-where-do-they-fit-clinical/page/0/1. Accessed March 22, 2019.

Share

Filed under: Rheumatology

Related
Best Practices in Individualizing Care for Patients With axSpA or PsA

Best Practices in Individualizing Care for Patient ...

Psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) are progressive, chronic inflammatory ...

Filed under: Rheumatology


Continue Reading
Best Practices in Individualizing Rheumatoid Arthritis Care

Best Practices in Individualizing Rheumatoid Arthr ...

Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes progressive damage to the li ...

Filed under: Rheumatology


Continue Reading
Sexual Health in Patients With Rheumatic Disease: How to Ask Sensitive Questions in a Clinical Setting

Sexual Health in Patients With Rheumatic Disease: ...

It is not easy to ask our patients about sexual health and functioning. The European Alliance of Ass ...

Filed under: Miscellaneous, Rheumatology


Continue Reading
Novel Medication Sequencing for Treatment of Osteoporosis

Novel Medication Sequencing for Treatment of Osteo ...

For the remainder of 2022, there are no new medications for osteoporosis expected to become availabl ...

Filed under: Orthopedics, Rheumatology


Continue Reading
Rheumatic Disease and Long-Haul COVID-19

Rheumatic Disease and Long-Haul COVID-19

Research presented at the most recent American College of Rheumatology (ACR) Convergence in November ...

Filed under: Infectious Diseases, Public Health, Rheumatology


Continue Reading
Cardiovascular Risk in Rheumatic Inflammatory Disease

Cardiovascular Risk in Rheumatic Inflammatory Dise ...

It is well documented that those with rheumatic inflammatory diseases have an increased risk of card ...

Filed under: Cardiometabolic, Rheumatology


Continue Reading