How effective are JAK inhibitors for treating psoriasis or psoriatic arthritis?

Psoriasis affects almost 1-3% of the general population and often manifests as erythematous scaling plaques. Topical ointments and phototherapy are the preferred treatments. However, they are unsuccessful in controlling moderate to severe cutaneous disease. Although synthetic and biological disease-modifying anti-rheumatic drugs (DMARDs) are found to be effective for treating psoriasis and psoriatic arthritis (PsA), the associated adverse effects limit their wider prescription.  Now a recent systematic review and meta-analysis published in Clinical Rheumatology have recommended Janus kinase (JAK) inhibitors as efficacious interventions for the treatment of psoriasis and PsA.

Fan Yang and co-researchers analyzed the data of 6802 patients from 17 clinical trials conducted until June 2021. The study has noted higher response rates with the use of JAK inhibitors, especially with filgotinib followed by upadacitinib, tofacitinib, and deucravacitinib when compared to placebo. In patients who received tofacitinib 10 mg twice daily, Psoriasis Area and Severity Index (PASI75) response rate was higher when compared to those who received tofacitinib 5 mg.

A similar meta-analysis conducted by Sarabia et al. (2022) has noted significant progress in PASI75 among patients treated with tofacitinib as opposed to placebo. The study evaluated 15 randomized control trials with 6757 patients and concluded that JAK inhibitors are safe and effective in treating moderate to severe psoriatic disease and PsA. The researchers also suggested JAK inhibitors as an alternative therapy for psoriatic patients nonresponsive to biological DMARDs.

Although JAK inhibitors have been recommended as a new class of drugs that can be used in systemic management of psoriasis, a higher dose is linked to increased toxicity. Hence, further investigations are needed to evaluate the long-term safety and efficacy of JAK inhibitors.

References

  1. Yang F, Lu C, Wang Y, Liu H, Leng X, Zeng X. Efficacy and safety of Janus kinase inhibitors in patients with psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Clinical Rheumatology. 2023 Feb 10:1-3.https://doi.org/10.1007/s10067-023-06529-4
  2. Sarabia S, Ranjith B, Koppikar S, Wijeratne DT. Efficacy and safety of JAK inhibitors in the treatment of psoriasis and psoriatic arthritis: a systematic review and meta-analysis. BMC Rheumatology. 2022 Sep 27;6(1):71. https://doi.org/10.1186/s41927-022-00287-7

 

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