Introduction: JAK (Janus kinase) is a type of non-receptor tyrosine kinase that includes JAK1, JAK2, JAK3, and Tyk2. Currently, there are five JAK inhibitors approved for treating rheumatoid arthritis. These inhibitors vary in their selectivity for different JAK isoforms.
Area covered: This review outlines the mode of actions and the results of Phase III trials of the JAK inhibitors which have been approved for the treatment of rheumatoid arthritis.
Expert commentary: JAK inhibitors have the potential to finely tune immunity and inflammation in patients with rheumatoid arthritis. The in vitro data indicates that IL-6 signaling is suppressed by all JAK inhibitors, while tofacitinib exhibits the most extensive suppression of cytokines via the JAK pathway. Peficitinib suppresses common gamma cytokines, and filgotinib suppresses interferon. Furthermore, baricitinib and upadacitinib appear to be inclined toward suppressing interferon and the IL-12 family. Despite their specific target profiles, any of these drugs can inhibit other JAKs if their blood levels surpass a certain threshold. As a result, predicting in vivo selectivity remains a challenging task. JAK inhibitor seems to be a vital treatment option for difficult-to-treat rheumatoid arthritis patients, and it is expected that precision medicine approaches will enhance its effectiveness in the future.
Keywords: JAK inhibitor; JAK-STAT pathway; baricitinib; filgotinib; peficitinib; tofacitinib; upadacitinib.