Pharmacology, efficacy and safety of JAK inhibitors in Crohn's disease. 2019

Christopher Ma, and Vipul Jairath, and Niels Vande Casteele
Division of Gastroenterology and Hepatology, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada; Robarts Clinical Trials, Inc, #200, 100 Dundas Street, London, Ontario, N6A 5B6, Canada.

Orally bioavailable inhibitors of the tyrosine kinases (TYKs), also referred to as Janus kinases (JAKs), are being evaluated for the treatment of patients with Crohn's disease (CD), ulcerative colitis (UC), and other chronic inflammatory disorders. To date, three JAK inhibitors have been tested in patients with moderate-to-severe CD: tofacitinib (pan-JAK inhibitor), filgotinib (JAK1 inhibitor) and upadacitinib (JAK1 inhibitor). Clinical development of tofacitinib was discontinued in CD because the primary endpoint of clinical remission in the phase II induction and maintenance trials was not met, although outcomes may have been influenced by trial design flaws and a high placebo rate was noted. In contrast, filgotinib did meet its primary endpoint of clinical remission at week 10 in the phase II FITZROY trial, in addition to several other clinically important secondary outcomes, spurring a subsequent larger phase III trial. Following promising results for upadacitinib in its phase II trial, larger phase III trials were also initiated to corroborate the efficacy results. Although JAK inhibitors appear to have an acceptable safety profile, higher rates of infections compared to placebo were noted. Overall, JAK inhibitors constitute a new promising class of drugs, given the efficacy signals observed in pivotal clinical trials in several chronic inflammatory diseases. Here we review the existing evidence on the pharmacology, safety and efficacy of JAK-STAT inhibitors that are currently under investigation for the treatment of patients with CD.

UI MeSH Term Description Entries
D003424 Crohn Disease A chronic transmural inflammation that may involve any part of the DIGESTIVE TRACT from MOUTH to ANUS, mostly found in the ILEUM, the CECUM, and the COLON. In Crohn disease, the inflammation, extending through the intestinal wall from the MUCOSA to the serosa, is characteristically asymmetric and segmental. Epithelioid GRANULOMAS may be seen in some patients. Colitis, Granulomatous,Enteritis, Granulomatous,Enteritis, Regional,Ileitis, Regional,Ileitis, Terminal,Ileocolitis,Crohn's Disease,Crohn's Enteritis,Inflammatory Bowel Disease 1,Regional Enteritis,Crohns Disease,Granulomatous Colitis,Granulomatous Enteritis,Regional Ileitides,Regional Ileitis,Terminal Ileitis
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000075242 Janus Kinase Inhibitors Agents that inhibit JANUS KINASES. JAK Inhibitor,Janus Kinase Inhibitor,JAK Inhibitors,Inhibitor, JAK,Inhibitor, Janus Kinase,Inhibitors, JAK,Inhibitors, Janus Kinase,Kinase Inhibitor, Janus,Kinase Inhibitors, Janus

Related Publications

Christopher Ma, and Vipul Jairath, and Niels Vande Casteele
August 2020, Journal of Crohn's & colitis,
Christopher Ma, and Vipul Jairath, and Niels Vande Casteele
March 2014, Leukemia research,
Christopher Ma, and Vipul Jairath, and Niels Vande Casteele
February 2022, Expert opinion on investigational drugs,
Christopher Ma, and Vipul Jairath, and Niels Vande Casteele
January 2019, Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology,
Christopher Ma, and Vipul Jairath, and Niels Vande Casteele
August 2016, Proceedings of the National Academy of Sciences of the United States of America,
Christopher Ma, and Vipul Jairath, and Niels Vande Casteele
October 2007, Expert review of gastroenterology & hepatology,
Christopher Ma, and Vipul Jairath, and Niels Vande Casteele
January 2014, Journal of immunology research,
Christopher Ma, and Vipul Jairath, and Niels Vande Casteele
June 2023, Cells,
Christopher Ma, and Vipul Jairath, and Niels Vande Casteele
November 2021, Journal of clinical medicine,
Christopher Ma, and Vipul Jairath, and Niels Vande Casteele
February 2012, La Tunisie medicale,
Copied contents to your clipboard!