Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

JAK-inhibition as a therapeutic strategy for refractory primary systemic vasculitides

Sujoy Khan
Download PDF
DOI: https://doi.org/10.7861/clinmed.Let.21.2.2
Clin Med March 2021
Sujoy Khan
Consultant immunologist, Castle Hill Hospital, Cottingham, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

Editor – I read with interest the vasculitis update by Mooikhin Hng and colleagues who mention tociluzumab (anti-IL-6) as a therapeutic option in refractory giant cell arteritis (GCA), and wish to add that tocilizumab has been used successfully in refractory polyarteritis nodosa (PAN).1,2 More importantly, patients with GCA who do not respond to biologics have few treatment options other than high doses of systemic corticosteroids.

These patients provide crucial learning experiences and the pressing need to understand pathogenesis of vasculitides in more detail. Inflammatory cytokines from effector T-cell subtypes allows self-sustained signalling in vasculitis and Janus-associated kinase inhibitors (JAKinibs; small molecules that inhibit JAK1, JAK2, JAK3 and Tyk2) have proven quite useful in controlling tissue inflammation in some refractory systemic vasculitis (supplementary material S1).5–9 Immunophenotyping data in large vessel vasculitides show distinct characteristics between GCA and Takayasu’s arteritis (TAK), but also have similarities such as Th1, Th-17 and Tfh cells involved in both disease relapses and such knowledge may help with personalised therapies.3 The IL6/JAK/STAT3 axis in systemic sclerosis was one of the initial models where the efficacy of tofacitinib as a potential anti-fibrotic agent was recognised, and was then shown to reverse graft-versus-host disease indicating multiple effects in lowering inflammation. Even with JAKinibs, it is clear that deep understanding in redundancy of pathways is necessary before considering a particular inhibitor for a trial/experimental therapy.

Successful clinical trials of small molecules in vasculitides will shed new light into pathogenesis, but biologic use requires careful consideration of added risks (infection or malignancy) while effectiveness also means the duration of treatment may be indefinite. Working with SHARE (Single-Hub Access for Pediatric Rheumatology in Europe) or vasculitis foundations will help physicians understand these difficult diseases and in improving patients’ lives.

Supplementary material

Additional supplementary material may be found in the online version of this article at www.rcpjournals.org/clinmedicine:

S1 – Use of JAKinibs in vasculitides.

  • © Royal College of Physicians 2021. All rights reserved.

References

  1. ↵
    1. Hng M
    , Zhao SS, Moots RJ. An update on the general management approach to common vasculitides. Clin Med 2020;20:572–9.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Akiyama M
    , Kaneko Y, Takeuchi T. Tocilizumab for the treatment of polyarteritis nodosa: a systematic literature review. Ann Rheum Dis 2020:annrheumdis-2020-218710 [Epub ahead of print].
  3. ↵
    1. Matsumoto K
    , Suzuki K, Yoshimoto K, et al. Significant association between clinical characteristics and changes in peripheral immuno-phenotype in large vessel vasculitis. Arthritis Res Ther 2019;21:304.
    OpenUrlPubMed
    1. Kuwabara S
    , Tanimura S, Matsumoto S, et al. Successful remission with tofacitinib in a patient with refractory Takayasu arteritis complicated by ulcerative colitis. Ann Rheum Dis 2020;79:1125–6.
    OpenUrlFREE Full Text
  4. ↵
    1. Saadoun D
    , Garrido M, Comarmond C, et al. Th1 and Th17 cytokines drive inflammation in Takayasu arteritis. Arthritis Rheumatol 2015;67:1353–60.
    OpenUrl
  5. ↵
    1. Rimar D
    , Alpert A, Starosvetsky E, et al. Tofacitinib for polyarteritis nodosa: a tailored therapy. Ann Rheum Dis 2016;75:2214–6.
    OpenUrlFREE Full Text
  6. ↵
    1. Liu J
    , Hou Y, Sun L, et al. A pilot study of tofacitinib for refractory Behçet’s syndrome. Ann Rheum Dis 2020;79:1517–20.
    OpenUrlFREE Full Text
  7. ↵
    1. Narazaki T
    , Shiratsuchi M, Tsuda M, et al. Intestinal Behçet’s disease with primary myelofibrosis involving trisomy 8. Acta Haematol 2019;142:253–6.
    OpenUrl
  8. ↵
    1. Sanchez GAM
    , Reinhardt A, Ramsey S, et al. JAK1/2 inhibition with baricitinib in the treatment of autoinflammatory interferonopathies. J Clin Invest 2018;128:3041–52.
    OpenUrlCrossRefPubMed
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
JAK-inhibition as a therapeutic strategy for refractory primary systemic vasculitides
Sujoy Khan
Clinical Medicine Mar 2021, 21 (2) e241-e242; DOI: 10.7861/clinmed.Let.21.2.2

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
JAK-inhibition as a therapeutic strategy for refractory primary systemic vasculitides
Sujoy Khan
Clinical Medicine Mar 2021, 21 (2) e241-e242; DOI: 10.7861/clinmed.Let.21.2.2
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Supplementary material
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • The association of pleural effusion and pulmonary embolism
  • What is the impact of COVID-19 on complaints against doctors?
  • The significance of the gut microbiome in post-COVID-19 gastrointestinal symptoms
Show more Letters to the editor

Similar Articles

FAQs

  • Difficulty logging in.

There is currently no login required to access the journals. Please go to the home page and simply click on the edition that you wish to read. If you are still unable to access the content you require, please let us know through the 'Contact us' page.

  • Can't find the CME questionnaire.

The read-only self-assessment questionnaire (SAQ) can be found after the CME section in each edition of Clinical Medicine. RCP members and fellows (using their login details for the main RCP website) are able to access the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:  https://cme.rcplondon.ac.uk

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians