Arghya Chattopadhyay MD, DM
Assistant Professor, Department of Rheumatology, North-Bengal Medical College & Hospital, Darjeeling.
JAK inhibitors have shown promising results in various arthritic conditions like rheumatoid arthritis (RA), psoriatic arthritis, ankylosing spondylitis etc. Baricitinib, a selective Janus kinase 1& 2 inhibitor, is already approved for use in RA, atopic dermatitis and alopecia areata. EF Morand et al. recently published a multicentric, double-blind, randomized, placebo-controlled, parallel-group, phase 3 study on using Baricitinib in adult patients with SLE. The study’s primary aim was to assess the efficacy and safety of Baricitinib 2mg and 4 mg and the standard of care in patients with moderate to severe active lupus. However, patients with active lupus nephritis and severe active CNS lupus were excluded from the study. Seven hundred sixty participants were included and randomized into Baricitinib 2mg, Baricitinib 4mg and placebo groups. The primary endpoint was the proportion of patients who achieved SLE Responder Index (SRI)-4 at week 52, those who received 4mg Baricitinib with the standard of care. Secondary endpoints were SRI-4 at week 52 for the Baricitinib 2 mg/day dose, the proportion of patients who achieved lupus low disease activity (LLDAS) at week 52 and the proportion of patients on >7.5mg prednisolone or equivalent. The primary endpoint in this study was met for the 4 mg baricitinib group. However, key secondary endpoints were not. No new safety concerns were observed. The current article supports the role of the JAK-STAT pathway in SLE pathogenesis; however, the negative secondary outcome emphasizes the complex pathogenic nature of SLE, and the effectiveness of baricitinib in SLE remains inconclusive as of now.
Intestinal pseudo-obstruction (IPO) in Systemic sclerosis is often refractory to conventional treatments, resulting in prolonged hospital stays and even mortality. Matsuda KM et al. recently reported 3 cases of IPO treated with intravenous immunoglobulin(IVIg) at 2gm/kg over five days and showed a rapid response to treatment. IVIg appears to be a promising mode of treatment for IPO, especially for refractory cases.