Evidence map›Paper›PMID 37490213›Full record

ReviewDrug safety2023

Managing Cardiovascular and Cancer Risk Associated with JAK Inhibitors.

Victor Yang, Tue W Kragstrup, Christopher McMaster, Pankti Reid, Namrata Singh, Stine R Haysen, Philip C Robinson, David F L Liew

Open access · hybridAbstract readReview
In one paragraph

Review in Drug safety, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 1 pooled it
10.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.

  1. European S2k Guideline on Chronic PruritusActa dermato-venereologica · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 6 institutions in 3 countries.

Victor YangDepartment of Rheumatology, Level 1, North Wing, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, PO Box 5444, Heidelberg West, VIC, 3081, Australia.ORCID http://orcid.org/0000-0003-0013-9865
Tue W KragstrupDepartment of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.ORCID http://orcid.org/0000-0002-6439-397X
Christopher McMasterDepartment of Rheumatology, Level 1, North Wing, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, PO Box 5444, Heidelberg West, VIC, 3081, Australia.ORCID http://orcid.org/0000-0003-2432-5451
Pankti ReidDivision of Rheumatology and Committee on Clinical Pharmacology and Pharmacogenomics, Department of Medicine, University of Chicago Biological Sciences Division, Chicago, IL, USA.ORCID http://orcid.org/0000-0002-7645-0919
Namrata SinghDivision of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, USA.ORCID http://orcid.org/0000-0001-7149-363X
Stine R HaysenDepartment of Biomedicine, Aarhus University, Aarhus, Denmark.ORCID http://orcid.org/0009-0006-7489-5339
Philip C RobinsonFaculty of Medicine, University of Queensland, Brisbane, QLD, Australia.ORCID http://orcid.org/0000-0002-3156-3418
David F L LiewDepartment of Rheumatology, Level 1, North Wing, Heidelberg Repatriation Hospital, Austin Health, 300 Waterdale Road, PO Box 5444, Heidelberg West, VIC, 3081, Australia. david.liew@austin.org.au.ORCID http://orcid.org/0000-0001-8451-8883
Aarhus University · DKThe University of Melbourne · AUHeidelberg Repatriation Hospital · AUThe University of Queensland · AUUniversity of Chicago · USUniversity of Washington · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Janus kinase inhibitors (JAKi) have enormous appeal as immune-modulating therapies across many chronic inflammatory diseases, but recently this promise has been overshadowed by questions regarding associated cardiovascular and cancer risk emerging from the ORAL Surveillance phase 3b/4 post-marketing requirement randomized controlled trial. In that study of patients with rheumatoid arthritis with existing cardiovascular risk, tofacitinib, the first JAKi registered for chronic inflammatory disease, failed to meet non-inferiority thresholds when compared with tumor necrosis factor inhibitors for both incident major adverse cardiovascular events and incident cancer. While this result was unexpected by many, subsequently published observational data have also supported this finding. Notably, however, such a risk has largely not yet been demonstrated in patients outside the specific clinical situation examined in the trial, even in the face of many studies examining this. Nevertheless, this signal has practically re-aligned approaches to both tofacitinib and other JAKi to varying extents, in other patient populations and contexts: within rheumatoid arthritis, but also in psoriatic arthritis, axial spondyloarthritis, inflammatory bowel disease, atopic dermatitis, and beyond. Application to individual patients can be more challenging but remains important to harness the substantive potential of JAKi to the maximum extent safely possible. This review not only explores the evolution of the regulatory response to the signal, its informing data, biological plausibility, and its impact on guidelines, but also the many factors that clinicians must consider in navigating cardiovascular and cancer risk for their patients considering JAKi as immune-modulating therapy.

Indexed as

Antirheumatic AgentsArthritis, PsoriaticArthritis, RheumatoidInflammatory Bowel DiseasesJanus Kinase InhibitorsNeoplasmsClinical Trials, Phase III as TopicHumansRandomized Controlled Trials as TopicAntirheumatic AgentsJanus Kinase Inhibitors

Identifiers

PMID37490213
PMCPMC10632271
OpenAlexW4385230169

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.