Hospital Pharmacy - November 2017 - 667

729668
research-article2017

HPXXXX10.1177/0018578717729668Hospital PharmacyTuran and Walker

Pharmaceutical Pipeline Update

Janus Kinase Inhibitors for the Treatment
of Rheumatoid Arthritis

Hospital Pharmacy
2017, Vol. 52(10) 667-668
© The Author(s) 2017
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https://doi.org/10.1177/0018578717729668
DOI: 10.1177/0018578717729668
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Senir Turan1 and Scot Walker2

Abstract
Rheumatoid arthritis (RA) is a disease where the immune system attacks the linings of the joints, resulting in joint pain,
stiffness, swelling, and destruction. Although many products are available for the treatment of RA, limitations such as adverse
reactions and tolerance greatly affect adherence. Many of the current biologic disease-modifying antirheumatic drugs on
the market are injectables, leaving a void to be filled for a product that can be taken orally. The most advanced of these
approaches, the Janus kinase (JAK) inhibitors, are oral drugs that have not only made a breakthrough in RA, but also other
skin conditions.
Keywords
intravenous therapy, formulary management/P&T, rheumatology

Epidemiology
Rheumatoid arthritis (RA) is the most common autoimmune
inflammatory arthritis in adults. The prevalence is 1% to 2% of
the adult population (0.3% of patients <35 years old and 10%
of those >65 years old).1 The usual age of onset for RA is
between 30 and 50 years. Rheumatoid arthritis affects 3 to 5
times more women than men. Prevalence does not increase
with age. It affects approximately 1.3 million people in the
United States. It is estimated that the direct health care costs, as
well as the consequential costs of RA in the United States, are
more than $19 billion annually. Conventional disease-modifying antirheumatic drugs (DMARDs) are small molecules and
inexpensive. They are much more affordable today than they
were several years ago. Most patients can expect to pay between
$1500 and $2000 annually for conventional DMARD medications. These costs will vary by the type and brand of medication. Biologics have a monthly cost that ranges from $1300 to
$3000. Biologics may cost the patient well over $30 000 annually without health insurance or financial assistance.2

Current Treatment
There are a few different approaches when considering pharmacologic therapy in treating RA. Current American College
of Rheumatology (ACR) and European League Against
Rheumatism (EULAR) guidelines recommend initiating
treatment with conventional DMARDs in patients with RA.
Methotrexate is the preferred DMARD to initiate in a new
patient. If disease activity is not decreased, then adding a
second DMARD or switching to a biologic DMARD with or
without methotrexate is recommended.

Many biologics are available for the treatment of RA.
These include tumor necrosis factor inhibitors (TNFi), abatacept, and the interleukin-6 receptor-alpha inhibitor, tocilizumab. Under certain circumstances, rituximab is also used.
Evidence is lacking regarding which biologics should be
used in and in what sequence. Most biologic DMARDs are
given by injection or infusion. Both traditional DMARDs
and biologics can increase the patient's risk for infection,
especially the increased risk for pneumonia with biologics.
Another problem is that not all available DMARDs, whether
traditional or biologic, prevent progressive joint damage, and
they do not always significantly improve quality of life.3

New Treatment Options
Janus kinase (JAK) inhibitors are in the nonreceptor tyrosine
kinase family, which play a pivotal role in the pathological
processes of RA. Several JAK inhibitors have been developed
as new therapies for patients with RA. These are all oral biologic DMARDs that inhibit JAK 1, 2, and 3. One JAK inhibitor, tofacitinib, has already been approved. Results of Phase III
clinical trials using the JAK 1, 2 inhibitor, baricitinib, have
shown promise. Both drugs are effective in patients who
showed inadequate response to biological DMARDs as well
1

St. Louis College of Pharmacy, MO, USA
Prescribe Right, LLC, Wildwood, MO, USA

Corresponding Author:
Scot Walker, Chief Executive Officer, Prescribe Right, LLC,
1602 Westglen Farms Dr, Wildwood, MO 63011, USA.
Email: scot.walker@prescriberight.com

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