1. Which JAK inhibitor is most likely to help me?
3. Will taking a JAK inhibitor shut down my immune system?
4. Why do I need to get certain vaccinations first?
5. Should I be worried about the black box warning on all JAK inhibitors?
2. If one JAK inhibitor doesn’t help me, does that mean none of them will?
6. JAK inhibitors are still pretty new – are you sure they’re safe?
7. Will I be able to afford this medication?
8. Will I have to take these medications forever?
9. Will I have to take these medications forever?
8. Will I be able to afford this medication?
7. JAK inhibitors are still pretty new – are you sure they’re safe?
6. I read that JAK inhibitors increase the risk of blood clots. Should I be worried?
5. Can taking a JAK inhibitor cause cancer?
FAQs About JAK Inhibitors, Answered
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FAQs About JAK Inhibitors for RA, Answered
BAUER: It’s hit or miss in terms of what we try. Tofacitinib has been around the longest, so it’s often the go-to for most people to start with. BOSE: The mechanisms are similar for all three, and all three work well in the right patient population. There’s no way to predetermine which might be a better fit. It takes some trial and error.
BOSE: If you’ve failed the first JAK inhibitor, you can try another JAK inhibitor before giving up on the class altogether. BAUER: If you have a not-so-good response, or maybe a partial response to the first one you try, then we would switch you to a different JAK inhibitor.
SMITH: This can be a common misunderstanding, as these medications do increase your risk of infection. Only a small part of your immune system is interfered with — the entire immune system is not shut down.
SMITH: Infection is a notable risk with these medications, so caution should be taken — especially in individuals at high risk of infection. BAUER: In general, it’s all the same vaccinations that are recommended for the general population, though I do strongly urge patients to get the shingles vaccine before starting a JAK inhibitor, due to the increased risk of zoster (shingles) with this medication.
BOSE: This black box warning was added as a result of the postmarketing study, which found some evidence that the use of tofacitinib in particular may come with an increased risk of cancer and serious heart-related problems, such as heart attack, stroke, and blood clots. A lot of high-potency drugs go through postmarketing surveillance, so we may see more and more of this come up as these types of drugs become more mainstream. It’s not meant to scare you. It’s done for patient safety, so you can work with your doctor to make more informed treatment decisions.
BAUER: One thing that’s made the news recently — and that patients are worried about — is that there’s a bit of an indication that these medications might increase the risk of a blood clot. Technically that risk is with the higher dose that’s used for treating ulcerative colitis — not for RA. Though we’re carrying it over as something for us to avoid in people with RA who have a history of blood clot; or if you develop a blood clot while on a JAK inhibitor, it would be a reason for us to stop the medication.
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BOSE: Even though the latest JAK inhibitor is fairly new, they have been around for quite a long time — since 2012. So we do have experience with JAK inhibitors. SMITH: We can certainly try a medication and frequently reassess — though most people find their medication to be less scary in reality than it sounds on TV or in handouts.
6. JAK inhibitors are still pretty new — are you sure they’re safe?
SMITH: Some people feel they are unable to afford JAK inhibitors — but that’s not true for most people. Very few people do not qualify with insurance or with patient assistance programs. BOSE: For people who get it through insurance, it’s a nominal copay. Though if your insurance doesn’t approve it, all three JAK inhibitors have very good patient assistance programs that can help you get your medication free for up to two years — and usually by that time, the drug is on formulary and you can appeal.
BOSE: Usually, if your disease gets better on medication, we don’t like to take you off of it because your disease might come right back. If you really want to get off the medication, we can sit down and have a discussion — but I generally urge patients to stick with a treatment that’s working.
