Clinical experience and safety of Janus kinase inhibitors in giant cell arteritis: a retrospective case series from Sweden

Per Eriksson; Oliver Skoglund; Cecilia Hemgren; Christopher Sjöwall

doi:10.3389/fimmu.2023.1187584

Clinical experience and safety of Janus kinase inhibitors in giant cell arteritis: a retrospective case series from Sweden

Front Immunol. 2023 May 25:14:1187584. doi: 10.3389/fimmu.2023.1187584. eCollection 2023.

Authors

Per Eriksson¹, Oliver Skoglund¹, Cecilia Hemgren², Christopher Sjöwall¹

Affiliations

¹ Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection/Rheumatology, Linköping University, Linköping, Sweden.
² Department of Internal Medicine, Division of Rheumatology, County Hospital Ryhov, Jönköping, Sweden.

Abstract

The Janus kinase (JAK)-STAT signaling pathway is relevant in both Takayasu and giant cell arteritis (GCA), and the use of JAK inhibitors (JAKi) in arthritis, psoriasis, and inflammatory bowel disease is nowadays common. Some evidence of the clinical efficacy of JAKi in GCA exists and a phase III randomized controlled trial (RCT) of upadacitinib is currently recruiting. In 2017, we started using barcitinib in a GCA patient with inadequate response to corticosteroids, and later on, we treated other 14 GCA patients with baricitinib/tofacitinib during intense follow-up. The retrospective data of these 15 individuals are here summarized. GCA was diagnosed based on the ACR criteria and/or imaging techniques combined with increased C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR) followed by a good initial response to corticosteroids. JAKi was initiated based on inflammatory activity, with increased CRP, presumably dependent on GCA with clinical symptoms, despite unsatisfying high doses of prednisolone. The mean age at JAKi initiation was 70.1 years and the mean exposure to JAKi was 19 months. From initiation, significant reductions in CRP were seen already at 3 (p = 0.02) and 6 (p = 0.02) months. A slower decrease was observed regarding ESR at 3 (p = 0.12) and 6 (p = 0.02) months. Furthermore, the daily prednisolone doses were reduced at 3 (p = 0.02) and 6 (p = 0.004) months. No GCA relapses were observed. Two patients were affected by serious infections, but JAKi therapy was retained or reintroduced after recovery. We present encouraging observational data on JAKi in GCA in one of the hitherto largest case series with long-term follow-up. Our clinical experiences will complement the results from the awaited RCT.

Keywords: Janus kinase inhibitor (JAKI); baricitinib; corticosteroids; giant cell (temporal) arteritis; inflammation; interleukin - 6; large vessel vasculitis; therapy -.

Publication types

Randomized Controlled Trial
Clinical Trial, Phase III
Research Support, Non-U.S. Gov't

MeSH terms

Arthritis*
Giant Cell Arteritis* / drug therapy
Humans
Janus Kinase Inhibitors* / adverse effects
Prednisolone
Sweden

Substances

Janus Kinase Inhibitors
Prednisolone

Grants and funding

This work was supported by grants from the Swedish Rheumatism Association, the Region Östergötland (ALF Grants), the Gustafsson Foundation, the King Gustaf V’s 80-year Anniversary Foundation, and the King Gustaf V and Queen Victoria’s Freemasons Foundation.