Some people with rheumatoid arthritis (RA) respond well to methotrexate alone, and others need to add a biologic drug like Enbrel (etanercept) or Humira (adalimumab) to the mix. But if those standard treatments aren’t sufficient, it may be time to talk to your doctor about a newer class of medication, called janus kinase inhibitors (aka JAK inhibitors or jakinibs).

Unlike older biologic drugs that are given via injection or infusion, jakinibs are taken orally. They work by blocking specific enzymes that would otherwise lead to inflammation and cause the immune system to overreact in people with RA.

In one recent study, presented at the 2018 annual meeting of the American College of Rheumatology (ACR), a jakinib called upadacitinib was more found to be more effective than Humira (adalimumab). Other research, also presented at the ACR meeting, found that another jakinib, peficitinib, was significantly more effective than a placebo. Similar studies have yielded equally promising results.

Upadacitimib and peficitinib are not yet on the market, but another jakinib, Xeljanz (tofacitinib), was FDA approved for people with moderate to severe RA in 2012.

Still, experts believe that more research is needed before jakinibs, including Xeljanx, are considered as a first-line treatment option for RA. This class of medication has been associated with a risk of shingles, blood clots, and high cholesterol, among other possible side effect. But the bigger issue may simply be that there’s more reason to trust older biologics, since they’ve been on the market much longer.

“JAK inhibitors have already found a place in treating those who fail one or more biologics,” Mark C. Genovese, MD, of Stanford University Medical Center in California, told MedPage Today. “And, increasingly, I think we’ll see these drugs used earlier, even in front of other biologics.”


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