Cardiovascular risk and JAK inhibitor for the treatment of spondyloarthritis: A systematic review.

OBJECTIVE: The aim of this review is to evaluate cardiovascular safety of Janus Kinas (JAK) inhibitors in patients with spondyloarthritis (SpA). METHODS: Applying the PRISMA methodology, we searched PubMed, Embase, and the Cochrane Library databases using the following search terms: Janus kinase inhibitors, spondyloarthritis, cardiac risk and major adverse cardiovascular event. Randomized controlled trials that reported Major Adverse Cardiovascular Events (MACE) in patients treated with JAK inhibitors for SpA were included. RESULTS: Ten radomized controlled trials conducted between 2017 and 2024 were analyzed, encompassing 2671 patients with an active SpA and treated with JAK inhibitors (tofacitinib, upadacitinib and filgotinib). The follow-up duration ranged from 12 to 104 weeks. Only three MACE were reported with upadacitinib (15 mg/day) : one non-fatal haemorrhagic stroke after 52 weeks of treatment in a patient with a history of smoking and a myocardial infarction and a cerebral hemorrhage after 104 weeks in the same population, corresponding to an incidence rate of 0.3 per 100 patient-years (95% CI: 0.0-1.1). CONCLUSIONS: This systemic review highlights the safety of JAK inhibitors according to MACE occurrence in patients with SpA when compared to placebo. These results need to be interpreted with caution regarding the limited long-term data and small sample sizes in clinical trials. Long-term studies are needed to clarify these risks.