JAK inhibitors: Evolving therapies in rheumatoid arthritis

In rheumatoid arthritis, there has been a paradigm shift from controlling symptoms to controlling the disease progress with abrogation of inflammation. Achieving this remission or very low disease activity has become increasingly possible with USA FDA approved first JAK inhibitor, Tofacitinib in November 2012 (not in Europe). This new small molecule JAK inhibitors are oral drug working intra-cellularly in comparison to TNFα inhibitors targeting a singly cytokine within extra-cellular space confining themselves to cell surface receptors. The second JAK inhibitor Baracitinib approved in Europe in February 2017 and in USA in May 2018 has greater promises. Once daily 2 mg oral dose used either as monotherapy or in combination with methotrexate in moderate to severe active rheumatoid arthritis in adults have provided remission, even in patients who have responded inadequately or are intolerant to one or more DMARDs / bDMARDs. It is a safe second line therapy after methotrexate. In DMARD naïve patients, it is likely to become first-line agents