Comparative Efficacy of JAK Inhibitors versus TNF Inhibitors in Moderate-to-Severe Rheumatoid Arthritis: A Systematic Review

Abstract

Introduction: Janus kinase (JAK) inhibitors are a class of oral targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) for rheumatoid arthritis (RA). Their comparative efficacy against established biologic DMARDs like tumor necrosis factor (TNF) inhibitors is a critical clinical question.

Methods: A search of MEDLINE and Embase was conducted for head-to-head RCTs. We included trials directly comparing a JAK inhibitor to a TNF inhibitor in patients with an inadequate response to methotrexate. The primary outcome was the ACR20 response rate.

Results: The review identified seven head-to-head trials. In general, JAK inhibitors demonstrated non-inferior, and in some analyses, superior efficacy compared to TNF inhibitors in achieving ACR20/50/70 responses and clinical remission. The safety profiles were broadly similar, though specific adverse events differed between classes.

Discussion: As oral agents with rapid onset of action, JAK inhibitors offer a convenient and effective alternative to injectable TNF inhibitors. The choice between these classes may depend on patient preference, safety considerations, and specific clinical profiles.

Conclusion: JAK inhibitors show comparable or superior efficacy to TNF inhibitors for the treatment of moderate-to-severe rheumatoid arthritis.