New treatment tools and challenges in rheumatoid arthritis

Abstract

Biologics have revolutionized the treatment of rheumatoid arthritis（RA）, with JAK inhibitors making their therapeutic effects possible through oral administration. The ORAL Surveillance trial, which directly compared JAK inhibitors with TNF inhibitors, did not demonstrate non-inferiority of JAK inhibitors. The interpretation of this study is complicated by the fact that TNF inhibitors have been reported to be effective in reducing the incidence of these events in RA patients. The results illustrate the importance of screening to the extent possible at the time of introduction of molecular-targeted therapies. Herpes zoster（HZ）is an adverse event that has received new attention with the JAK inhibitor trials. However, HZ has been known to be increased in RA patients for some time, and JAK inhibitors increase the frequency of HZ 2- to 3-fold, and the incidence in Japan is 2-fold higher from rest of the world. The proactive prophylaxis with Shingrix, a subunit vaccine, should be taken. In consideration of cost and expense for screening and vaccination, countermeasures against adverse events of molecular-targeted therapy is closely related to the fundamental issue of shared-decision making.