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Comparison of Janus kinase inhibitors in the treatment of rheumatoid arthritis: a systemic literature review


Jegatheeswaran J1, Turk M1, Pope JE1,2. Immunotherapy. 2019 Jun;11(8):737-754. doi: 10.2217/imt-2018-0178. Epub 2019 Apr 8.

Author Information

1 University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Medicine, London, ON, Canada.

2 Professor of Medicine, Division of Rheumatology, St. Joseph's Health Care & University of Western Ontario, London, Ontario, Canada.


Several Janus kinase (JAK) inhibitors, oral targeted disease-modifying drugs, will be approved for the treatment of rheumatoid arthritis (RA) and other diseases. This review compares and contrasts the efficacy of JAK inhibitors (tofacitinib, baricitinib, upadacitinib, filgotinib, peficitinib and decernotinib) in RA including: early RA methotrexate-naive patients, post methotrexate failure and post biologics. Trials in monotherapy, combination with disease modifying drugs such as methotrexate, and comparing with adalimumab in biologic-naive patients were studied. The efficacy is superior to methotrexate in naive patients and equal or superior to adalimumab depending on the drug and dose. There is a class effect of adverse events. Serious infections occur at a rate similar to other advanced therapies in RA, although more reactivation of herpes zoster occurs.