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JAK Inhibitor vs Biologic DMARD: What's the Difference?

Deciding whether to use a biologic therapy or a Janus kinase (JAK) inhibitor to treat rheumatoid arthritis (RA) is complicated. They are both disease-modifying anti-rheumatic drugs (DMARDs). DMARDs treat the symptoms of RA and change the disease course by slowing or preventing the damage to joints and surrounding tissues. However, there are a few key differences between the types.1-3

How do biologic DMARDs work?

Biologic DMARDs are proteins made from genetic material. They work by interfering with specific pathways that activate the inflammatory responses that cause RA. Instead of acting on the immune system as a whole, like conventional or traditional DMARDs, biologics target and block specific molecules on immune system cells. This reduces or prevents the inflammatory response that is common in RA.2 Examples of biologic DMARDs include Enbrel, Humira, Rituxan, and Orencia to name a few.

When are biologics used in RA treatment?

Biologic DMARDs are typically used if a conventional DMARD, like methotrexate, did not work well enough. Or, a biologic may be added to a traditional DMARD to get better results. However, for people who have more severe or aggressive RA, biologics can be used as a first-line treatment.1-4

People taking biologics may start to see improvement in symptoms between 4 to 8 weeks, depending on the drug. Biologics need to be injected or given through an intravenous (IV) infusion.1

How do JAK inhibitors work?

JAK inhibitors are target-specific DMARDs that affect only specific enzymes called jakinibs (JAK1, JAK2 and JAK3). Jakinibs send chemical messages that trigger inflammation. JAK inhibitors block the jakinibs signal which prevents the immune system from having an inflammatory response.3-6 Examples of JAK inhibitors include Xeljanz, Olumiant, and Rinvoq.

When are JAK inhibitors used in RA treatment?

A JAK inhibitor can be used for moderate to severe RA when the first drug for treating RA doesn’t work well enough, or if the first therapy causes unpleasant side effects. Or, it can be added to another treatment, like methotrexate. Combining the 2 can help some RA patients achieve better results.3,4

While many other treatments work outside the cell, like biologic DMARDs, the JAK inhibitors work inside the cell to prevent inflammation. Also, JAK inhibitors are taken orally instead of injections or infusions.1,3,4

Various medications for RA treatment can take months to work. One difference with JAK inhibitors is that research has shown that they can start working faster to relieve symptoms, with improvements being seen within days.4,5

Which treatment is right for me?

Several factors must be considered when deciding on RA treatment, like the disease activity, any prior treatments, and side effects. Biologics have a longer history of use, but JAK inhibitors are newer. Both have shown the ability to alleviate RA symptoms and can be effective when used alone or in combination with other therapies.1,4

Like all medications, both treatments have the potential for serious side effects. Because they suppress the immune system, they can make it easier to get an infection. They can also increase the risk of getting certain types of cancer.2,4

You and your doctor will work together to determine which treatment is appropriate for you.

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