Evidence map›Paper›PMID 38216757›Full record

ReviewNature reviews. Rheumatology2024

Efficacy and safety of JAK inhibitors in rheumatoid arthritis: update for the practising clinician.

Zoltán Szekanecz, Maya H Buch, Christina Charles-Schoeman, James Galloway, George A Karpouzas, Lars Erik Kristensen, Steven R Ytterberg, Attila Hamar, Roy Fleischmann

Erratum issuedAbstract readReview
PubMed Publisher
In one paragraph

Review in Nature reviews. Rheumatology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 78 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
78citing papers in PubMed, 7 pooled it
50.3field-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

78 citing papers in PubMed, 7 syntheses or guidelines pooled it, 107 citations in OpenAlex.

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  15. Emerging therapies in idiopathic inflammatory myopathies.Journal of neuromuscular diseases · 2026
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18 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 7 institutions in 4 countries.

Zoltán SzekaneczDepartment of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary. szekanecz.zoltan@med.unideb.hu.ORCID http://orcid.org/0000-0002-7794-6844
Maya H BuchCentre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.ORCID http://orcid.org/0000-0002-8962-5642
Christina Charles-SchoemanDivision of Rheumatology, Department of Medicine, Harbour-University of California Los Angeles Medical Centre, Los Angeles, CA, USA.
James GallowayDepartment of Inflammation Biology and Centre for Rheumatic Diseases, King's College London, London, UK.ORCID http://orcid.org/0000-0002-1230-2781
George A KarpouzasDivision of Rheumatology, Department of Medicine, Harbour-University of California Los Angeles Medical Centre, Los Angeles, CA, USA.ORCID http://orcid.org/0000-0003-1065-1563
Lars Erik KristensenThe Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
Steven R YtterbergDivision of Rheumatology, Mayo Clinic, Rochester, MN, USA.
Attila HamarDepartment of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Roy FleischmannMetroplex Clinical Research Center and University of Texas Southwestern Medical Center, Dallas, TX, USA.ORCID http://orcid.org/0000-0002-6630-1477
University of California, Los Angeles · USUniversity of Debrecen · HUKing's College London · GBManchester Academic Health Science Centre · GBMayo Clinic in Arizona · USMetroplex Clinical Research Center · USUniversity of Copenhagen · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Janus kinase (JAK) inhibitors, including tofacitinib, baricitinib, upadacitinib and filgotinib, are increasingly used in the treatment of rheumatoid arthritis (RA). There has been debate about their safety, particularly following the issuance of guidance by regulatory agencies advising caution in their use in certain patients. The registrational clinical trials and registry data of JAK inhibitors did not identify a difference in the risk of major adverse cardiovascular events (MACEs), venous thromboembolism, malignancies or infections (other than herpes zoster) with a JAK inhibitor versus a biologic DMARD. In the ORAL Surveillance trial, which enrolled patients >50 years of age with ≥1 cardiovascular risk factor, tofacitinib was statistically inferior to TNF inhibitors for the occurrence of MACEs and malignancy. Further post hoc analysis of the data revealed that an age of ≥65 years, a high baseline cardiovascular risk, a history of smoking, sustained inflammation, disease activity and suboptimal treatment of cardiovascular comorbidities all increase the risk of these outcomes. The guidance issued by regulatory agencies should be carefully considered to ensure appropriate and safe treatment of patients with RA without undertreatment of patients who might benefit from JAK inhibitor, as well as biologic, treatment. As always, the risks associated with the use of these agents, treatment goals, costs and patient preferences should be discussed with the patient.

Indexed as

Antirheumatic AgentsArthritis, RheumatoidBiological ProductsJanus Kinase InhibitorsNeoplasmsAgedHumansAntirheumatic AgentsBiological ProductsJanus Kinase Inhibitors

Identifiers

PMID38216757
OpenAlexW4390791027

What Socratic holds

Textmetadata
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.