The New England Journal of Medicine (NEJM) paper published last week reminded me to write this post.
We’ve been lucky in Australia to have access to the JAK-inhibitor, Tofacitinib (trade name, Xeljanz). It’s been a welcome addition to the medications we have available to treat rheumatoid arthritis.
Xeljanz has been used more widely than was expected and as I consider my own prescribing of the medication, there are clear reasons:
It’s a pill. Some people have a clear preference to take a medication orally rather than have an injection. This is somewhat opposed to my own bias if I had to use medications myself. I think I would personally like to avoid having to take daily medications and I would prefer an injection intermittently as long as the interval is long enough (biologic medication options used in rheumatology can be given 1 weekly, 2 weekly, 4 weekly & even 12 weekly in psoriatic arthritis).
Many of the biologic medications used in rheumatoid arthritis seem to work better when used in combination with Methotrexate. Xeljanz can be used as monotherapy, that is, without Methotrexate. There is good trial evidence that it is still effective in this way. This makes it one of two choices (the other being Tocilizumab (trade name, Actemra)) for those who cannot tolerate or who don’t want to take Methotrexate.
The NEJM paper presented the 52-week results for the BEAM trial where Baricitinib (a JAK 1, 2 inhibitor) was compared to Adalimumab (trade name, Humira).
1305 patients who had rheumatoid which was incompletely controlled on Methotrexate were randomised to receive either placebo, 4mg daily of Baricitinib or Adalimumab 40mg every fortnight.
Both Baricitinib and Adalimumab were clearly superior to placebo.
The exciting news was that Baricitinib performed better than Adalimumab in a number of outcome measures at various time points during the trial.
This is an important result and clearly shows how effective this oral medication is.
What we need now is longer term data to convince us that these medications are at least as safe or safer than the current biologic DMARDs in widespread use.
Many have bet that JAK inhibitor medications will play a big part in rheumatoid arthritis management.
Looks like they're going to be correct.
The link to the paper: http://www.nejm.org/doi/full/10.1056/NEJMoa1608345