1. JAK inhibitors are still pretty new. How do I know they’re safe?
3. Do JAK inhibitors shut down my immune system?
4. Can taking a JAK inhibitor cause cancer?
5. Will I be able to afford this medication?
6. What happens if I miss a dose?
2. Why do I need certain vaccinations first?
7. Will I keep taking other psoriatic arthritis medications while taking a JAK inhibitor?
8. Will I have to take this medication forever?
FAQs About JAK Inhibitors for Psoriatic Arthritis, Answered
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9. What happens if a JAK inhibitor doesn’t help me?
Although the first JAK inhibitor was approved for use in psoriatic arthritis in 2017, these drugs have been used to treat RA since 2012. To gain FDA approval, drugs go through a rigorous testing process in clinical trials, which includes testing for safety. A review of clinical trials published in 2020 in the journal RMD Open looked at the safety of JAK inhibitors in people with RA and found that overall, tofacitinib was very safe and had few discontinuations due to side effects. Although JAK inhibitors now come with a black box warning as a result of the postmarketing safety study, they are still a safe, viable option for many people with psoriatic arthritis who have good heart health. Your doctor will take into consideration your psoriatic arthritis as well as your overall health to determine whether JAK inhibitors make sense for you, as well as monitor you closely while you’re taking a JAK inhibitor to make sure you don’t experience any issues.
Because JAK inhibitors affect the immune system, your doctor may want you to get necessary vaccinations prior to starting this medication. “It’s recommended that you’re up to date with all of your vaccinations before taking a JAK inhibitor or a biologic, because we want the vaccination to be maximally effective,” Mandelin explains. Your doctor will likely suggest the same vaccinations that are recommended for the general population, though there may be more urgency for a shingles shot, as JAK inhibitors may increase the risk.
While JAK inhibitors don’t shut down your immune system, they do alter it. “JAK inhibitors and biologics are immunomodulators. They basically turn down the volume on the immune system,” Mandelin says. “Because psoriatic arthritis involves an overactive immune system, we don’t really think about this as turning the immune system down as much as we think about normalizing it back to where it’s supposed to be.” Of course, this alteration can sometimes leave you more vulnerable to infection, which is why you’ll be monitored closely. You should also take extra precautions against illnesses like the cold, flu, RSV, and COVID-19. For example, wash your hands regularly, disinfect frequently used surfaces, and avoid contact with others who are sick.
As with biologics, there have been a small number of cancer cases reported with JAK inhibitors. “The main things that we watch for are lymphomas,” which are blood cancers, says Mandelin. But the risk is small: “If you put 200 patients on a JAK inhibitor for a year, you’d expect to see one cancer,” Mandelin explains.
You’ll want to make sure that JAK inhibitor treatment is covered by your insurance plan. “There are some insurance companies that are going to want people to try a biologic injectable medication first,” Mandelin says. Even with insurance coverage, you’ll still have a copay. Check the drug manufacturer’s website for financial assistance programs or visit the Medicine Assistance Tool, a search engine for drug assistance programs.
Because a JAK inhibitor is taken orally on a daily basis, “For most people, missing one dose is not going to make a huge difference,” Mandelin says. “Generally, I will tell people, just restart with your next dose and don’t try to make up for the missed one.” If you think you might forget to take it on a daily basis, try setting a reminder on your phone or putting a prefilled weekly pillbox next to your morning coffee mug.
This will depend on your particular case. You might take the JAK inhibitor on its own or along with a traditional DMARD, such as methotrexate. But you won’t take a biologic at the same time as a JAK inhibitor, because they are both targeted treatments. “That would mean you’re basically over-suppressing the immune system,” explains Mandelin.
You’ll continue to take a JAK inhibitor on a daily basis for as long as it works for you. “These drugs are not curing the disease; they are suppressing it,” Mandelin says. “And if a person stops taking the medication, generally speaking, the disease will come back.”
If the JAK inhibitor isn’t effective or stops working at some point, your doctor will likely switch you to — or back to — a biologic. Now that there are two JAK inhibitors approved for use in psoriatic arthritis, you may also be able to try the other JAK inhibitor if the first one doesn’t work. “We sometimes have to just do trial and error to find the medication that a person likes,” Mandelin says.
