THERAPY WITH JAK INHIBITORS AND THE RISK OF CARDIOVASCULAR EVENTS IN A DUTCH RHEUMATOID ARTHRITIS POPULATION
Authors: C. Popa et al.
INCIDENCE OF MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH JAK-INHIBITORS COMPARED TO BDMARDS: DATA FROM AN INTERNATIONAL COLLABORATION OF REGISTRIES (THE “JAK-POT” STUDY)
Authors: R. Aymon et al.
Since the publication of the ORAL-surveillance study, caution has been ordered when using Janus kinase inhibitors (JAKi) in patients with cardiovascular risk factors. Both these large observational studies explored the occurrence of major cardiovascular events (MACE) in a large population of RA patients treated with either JAK-inhibitors or alternative bDMARDs. Both studies reported similar incidence of MACE on JAK-inhibitors and on bDMARDs: The adjusted incidence risk ratio (IRR) in the Dutch study was 0.78 (CI 0.56-1.10) for JAKi compared to bDMARDs, the IRR was 0.87 (CI: 0.56 – 1.35) for JAKi compared to anti-TNF in the Swiss study (JAK-pot).
While caution is still warranted, in these large real-world studies, the incidence of cardiovascular events on JAKi was not higher than on bDMARDs. Several explanations are possible for the discrepant results between the original ORAL-surveillance and a number of observational studies. Perhaps, the cardiovascular risk factors are better taken into account by clinicians in real world RA patients; perhaps ORAL surveillance was an outlier or the patient population included in this study differs from patients seen routinely in clinical practice in western Europe? Before we can start relaxing our current ‘cardiovascular prudence’ with JAKi, we will need to understand the mechanisms and the particular interactions that may lead to MACE with this class of drugs.