Points to consider for the treatment of immune-mediated inflammatory diseases with Janus kinase inhibitors: a consensus statement

Author:

Nash PeterORCID,Kerschbaumer AndreasORCID,Dörner ThomasORCID,Dougados Maxime,Fleischmann Roy MORCID,Geissler Klaus,McInnes Iain,Pope Janet EORCID,van der Heijde DésiréeORCID,Stoffer-Marx Michaela,Takeuchi Tsutomu,Trauner Michael,Winthrop Kevin LORCID,de Wit MaartenORCID,Aletaha DanielORCID,Baraliakos Xenofon,Boehncke Wolf-Henning,Emery PaulORCID,Isaacs John D,Kremer Joel,Lee Eun BongORCID,Maksymowych Walter PORCID,Voshaar Marieke,Tam Lai-Shan,Tanaka YoshiyaORCID,van den Bosch Filip,Westhovens RenéORCID,Xavier Ricardo,Smolen Josef SORCID

Abstract

ObjectivesJanus kinase inhibitors (JAKi) have been approved for use in various immune-mediated inflammatory diseases. With five agents licensed, it was timely to summarise the current understanding of JAKi use based on a systematic literature review (SLR) on efficacy and safety.MethodsExisting data were evaluated by a steering committee and subsequently reviewed by a 29 person expert committee leading to the formulation of a consensus statement that may assist the clinicians, patients and other stakeholders once the decision is made to commence a JAKi. The committee included patients, rheumatologists, a gastroenterologist, a haematologist, a dermatologist, an infectious disease specialist and a health professional. The SLR informed the Task Force on controlled and open clinical trials, registry data, phase 4 trials and meta-analyses. In addition, approval of new compounds by, and warnings from regulators that were issued after the end of the SLR search date were taken into consideration.ResultsThe Task Force agreed on and developed four general principles and a total of 26 points for consideration which were grouped into six areas addressing indications, treatment dose and comedication, contraindications, pretreatment screening and risks, laboratory and clinical follow-up examinations, and adverse events. Levels of evidence and strengths of recommendations were determined based on the SLR and levels of agreement were voted on for every point, reaching a range between 8.8 and 9.9 on a 10-point scale.ConclusionThe consensus provides an assessment of evidence for efficacy and safety of an important therapeutic class with guidance on issues of practical management.

Funder

AbbVie

Eli Lilly and Company

Publisher

BMJ

Subject

General Biochemistry, Genetics and Molecular Biology,Immunology,Immunology and Allergy,Rheumatology

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