JAMA Netw Open

JAK inhibitors show similar safety to TNF antagonists

September 16, 2025

Study details: This systematic review and meta-analysis included head-to-head comparative effectiveness studies of adults with immune-mediated inflammatory diseases (IMIDs; including rheumatoid arthritis, inflammatory bowel disease, psoriasis/psoriatic arthritis, and spondyloarthritis) treated with JAK inhibitors or TNF antagonists. Primary outcomes were serious infections, malignant neoplasms, major adverse cardiovascular events (MACEs), and venous thromboembolism (VTE).

Results: Across 42 studies with 813,881 patients, there were no meaningful differences in the risk of serious infections, malignancy, MACEs, or VTE between JAK inhibitors and TNF antagonists. Incidence of serious adverse events was low in both groups. Notably, a modestly increased risk of VTE was observed with JAK inhibitors in rheumatoid arthritis, particularly with baricitinib, but not in other IMIDs.

Clinical impact: These findings support the use of JAK inhibitors as a safe alternative to TNF antagonists in IMIDs, provided that patient selection and monitoring are optimized. The results are more generalizable than prior studies limited to high-risk populations and inform shared decision-making regarding advanced therapies in IMIDs.

Source:

Solitano V, et al. (2025, September 2). JAMA Netw Open. Comparative Safety of JAK Inhibitors vs TNF Antagonists in Immune-Mediated Inflammatory Diseases: A Systematic Review and Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/40928778/