JAK-inhibitors: pharmacological properties and comparative clinical efficacy and safety

JAK-inhibitors interrupt the intracellular JAK-STAT signalling pathway that mediates action of various cytokines which are involved in the pathogenesis of rheumatoid arthritis (RA) and other immune-mediated inflammatory diseases. The objective of literature review was to compare the results of clinical trials of three JAK-inhibitors, that is, tofacitinib, baricitinib and upadacitinib, that differ in selectivity against JAK, in patients with RA. We have found no direct head-to-head clinical trials of JAK-inhibitoris. However, in the randomized controlled trials both non-selective (tofacitinib and baricitinib) and selective (upadacitinib) JAK-inhibitors were proved to be more effective than placebo and were associated with the similar response rates. Safety profiles of JAK-inhibitors were also comparable.