Is JAK inhibition the right choice for patients with relapsing giant cell arteritis?

Treatment with JAK inhibitors led to high response rates in patients with giant cell arteritis (GCA) who experienced a flare-up while on standard treatment. In a retrospective study, increasing rates of clinical remission and complete remission were observed after 12 months.

Patients with GCA have a considerable chance of relapse with a risk in the range of 30– 75% over time, especially during the first 2 years of the disease [1]. Since the JAK/STAT pathway plays a role in GCA, Dr Fernando López Gutiérrez (University Hospital Ramón y Cajal, Spain) and colleagues were interested in the safety and efficacy of JAK inhibitors as a treatment for patients who relapsed while on treatment with corticosteroids, methotrexate, or tocilizumab [2,3]. They performed a retrospective investigation with real-world data of patients in routine clinical practice.

The study included 35 participants, who received treatment with either baricitinib (n=15), tofacitinib (n=10), or upadacitinib (n=10). Clinical remission and complete remission outcomes were assessed up to 1 year after starting JAK inhibition. The patients had a mean age of 72.3 years and 86% were women. Before commencing JAK inhibition, GCA was known for a median of 30 months, 43% suffered from headaches, and 57% had large-vessel involvement. The median C-reactive protein level was 0.9 mg/dL and the median erythrocyte sedimentation rate was 28 mm/1^st hour. Previous experience with methotrexate was present in 63% and with tocilizumab in 86%. The median daily dose of prednisone was 16.2 mg.

At 1 year, clinical remission was achieved by 70% of the participants, climbing from 51% at 1 month to 54% at 3 months, and 61% after 6 months. Corresponding proportions for complete remission were 65%, 43%, 48%, and 57%. Adverse events were reported in 5 participants. One case each of herpes zoster, urinary tract infection, elevation of liver enzymes, and glioblastoma multiforme, and 1 patient with dyspnoea and palpitations.

The authors recommend that these results, which suggest the efficacy of JAK inhibitors in patients with GCA who fail standard-of-care options, are confirmed by randomised-controlled trials.

1. Pugh D, et al. Nat Rev Dis Primers. 2022;7:93.
2. Quartuccio L, et al. Rheumatology (Oxford). 2023;62:2032-2034.
3. López Gutiérrez F, et al. Effectiveness of Janus kinase inhibitors in relapsing giant cell arteritis in real-world clinical practice and review of literature. POS0077, EULAR 2024 Congress, 12–15 June, Vienna, Austria.

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Posted on 29 July 202429 July 2024