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Taylor PC, Choy E, Baraliakos X, Szekanecz Z, Xavier RM, Isaacs JD, Strengholt S, Parmentier JM, Lippe R, Tanaka Y. Differential properties of Janus kinase inhibitors in the treatment of immune-mediated inflammatory diseases. Rheumatology (Oxford) 2024; 63:298-308. [PMID: 37624925 PMCID: PMC10836981 DOI: 10.1093/rheumatology/kead448] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/03/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Janus kinases (JAKs) are a family of cytosolic tyrosine kinases that regulate cytokine signal transduction, including cytokines involved in a range of inflammatory diseases, such as RA, psoriasis, atopic dermatitis and IBD. Several small-molecule JAK inhibitors (JAKis) are now approved for the treatment of various immune-mediated inflammatory diseases. There are, however, key differences between these agents that could potentially translate into unique clinical profiles. Each JAKi has a unique chemical structure, resulting in a distinctive mode of binding within the catalytic cleft of the target JAK, and giving rise to distinct pharmacological characteristics. In addition, the available agents have differing selectivity for JAK isoforms, as well as off-target effects against non-JAKs. Other differences include effects on haematological parameters, DNA damage repair, reproductive toxicity and metabolism/elimination. Here we review the pharmacological profiles of the JAKis abrocitinib, baricitinib, filgotinib, peficitinib, tofacitinib and upadacitinib.
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Affiliation(s)
- Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ernest Choy
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Zoltan Szekanecz
- Faculty of Medicine, Department of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Ricardo M Xavier
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University and Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Julie M Parmentier
- Immunology Precision Medicine, AbbVie Bioresearch Center, Worcester, MA, USA
| | - Ralph Lippe
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Mohamed MF, Bhatnagar S, Parmentier JM, Nakasato P, Wung P. Upadacitinib: Mechanism of action, clinical, and translational science. Clin Transl Sci 2024; 17:e13688. [PMID: 37984057 PMCID: PMC10771099 DOI: 10.1111/cts.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023] Open
Abstract
Upadacitinib is a selective Janus kinase (JAK) inhibitor which is approved by the US Food and Drug Administration, the European Medicines Agency, as well as other agencies around the world for the treatment of several chronic inflammatory diseases, including rheumatic, dermatologic, and gastrointestinal diseases. Through inhibition of JAK, upadacitinib inhibits phosphorylation of downstream effector proteins, which consequently inhibits cytokine signaling for key pathways involved in inflammatory diseases. Upadacitinib more potently inhibits JAK1 than other JAK isoforms. The pharmacokinetics, pharmacodynamics, efficacy, and safety of upadacitinib were characterized in many clinical trials, which demonstrated the superiority of upadacitinib treatment over placebo or an active comparator in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, atopic dermatitis, Crohn's disease, and ulcerative colitis. The safety profile of upadacitinib supported a favorable benefit-risk profile across all the approved indications. In this article, we review the mechanism of action of upadacitinib and describe how the JAK-STAT (Janus kinase-signal transducers and activators of transcription) pathway is involved in the pathogenesis of several chronic and progressive immune-mediated inflammatory diseases. In addition, this review also provides an overview of key clinical trials that were conducted as well as relevant data which supported the clinical development of upadacitinib and informed the recommended dose(s) in each of the approved indications.
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Affiliation(s)
| | | | | | | | - Peter Wung
- Clinical DevelopmentAbbVieNorth ChicagoIllinoisUSA
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3
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Parmentier JM, Voss J, Graff C, Schwartz A, Argiriadi M, Friedman M, Camp HS, Padley RJ, George JS, Hyland D, Rosebraugh M, Wishart N, Olson L, Long AJ. In vitro and in vivo characterization of the JAK1 selectivity of upadacitinib (ABT-494). BMC Rheumatol 2018; 2:23. [PMID: 30886973 PMCID: PMC6390583 DOI: 10.1186/s41927-018-0031-x] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/09/2018] [Indexed: 12/31/2022] Open
Abstract
Background Anti-cytokine therapies such as adalimumab, tocilizumab, and the small molecule JAK inhibitor tofacitinib have proven that cytokines and their subsequent downstream signaling processes are important in the pathogenesis of rheumatoid arthritis. Tofacitinib, a pan-JAK inhibitor, is the first approved JAK inhibitor for the treatment of RA and has been shown to be effective in managing disease. However, in phase 2 dose-ranging studies tofacitinib was associated with dose-limiting tolerability and safety issues such as anemia. Upadacitinib (ABT-494) is a selective JAK1 inhibitor that was engineered to address the hypothesis that greater JAK1 selectivity over other JAK family members will translate into a more favorable benefit:risk profile. Upadacitinib selectively targets JAK1 dependent disease drivers such as IL-6 and IFNγ, while reducing effects on reticulocytes and natural killer (NK) cells, which potentially contributed to the tolerability issues of tofacitinib. Methods Structure-based hypotheses were used to design the JAK1 selective inhibitor upadacitinib. JAK family selectivity was defined with in vitro assays including biochemical assessments, engineered cell lines, and cytokine stimulation. In vivo selectivity was defined by the efficacy of upadacitinib and tofacitinib in a rat adjuvant induced arthritis model, activity on reticulocyte deployment, and effect on circulating NK cells. The translation of the preclinical JAK1 selectivity was assessed in healthy volunteers using ex vivo stimulation with JAK-dependent cytokines. Results Here, we show the structural basis for the JAK1 selectivity of upadacitinib, along with the in vitro JAK family selectivity profile and subsequent in vivo physiological consequences. Upadacitinib is ~ 60 fold selective for JAK1 over JAK2, and > 100 fold selective over JAK3 in cellular assays. While both upadacitinib and tofacitinib demonstrated efficacy in a rat model of arthritis, the increased selectivity of upadacitinib for JAK1 resulted in a reduced effect on reticulocyte deployment and NK cell depletion relative to efficacy. Ex vivo pharmacodynamic data obtained from Phase I healthy volunteers confirmed the JAK1 selectivity of upadactinib in a clinical setting. Conclusions The data presented here highlight the JAK1 selectivity of upadacinitinib and supports its use as an effective therapy for the treatment of RA with the potential for an improved benefit:risk profile. Electronic supplementary material The online version of this article (10.1186/s41927-018-0031-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julie M Parmentier
- 1Immunology Discovery Research, AbbVie Bioresearch Center, 100 Research Dr, Worcester, MA 01605 USA
| | - Jeff Voss
- 1Immunology Discovery Research, AbbVie Bioresearch Center, 100 Research Dr, Worcester, MA 01605 USA
| | - Candace Graff
- 1Immunology Discovery Research, AbbVie Bioresearch Center, 100 Research Dr, Worcester, MA 01605 USA
| | - Annette Schwartz
- 1Immunology Discovery Research, AbbVie Bioresearch Center, 100 Research Dr, Worcester, MA 01605 USA
| | - Maria Argiriadi
- 1Immunology Discovery Research, AbbVie Bioresearch Center, 100 Research Dr, Worcester, MA 01605 USA
| | - Michael Friedman
- 1Immunology Discovery Research, AbbVie Bioresearch Center, 100 Research Dr, Worcester, MA 01605 USA
| | - Heidi S Camp
- 2Immunology Clinical Development, AbbVie, 1 North Waukegan Rd, North Chicago, IL 60064 USA
| | - Robert J Padley
- 2Immunology Clinical Development, AbbVie, 1 North Waukegan Rd, North Chicago, IL 60064 USA
| | - Jonathan S George
- 1Immunology Discovery Research, AbbVie Bioresearch Center, 100 Research Dr, Worcester, MA 01605 USA
| | - Deborah Hyland
- 1Immunology Discovery Research, AbbVie Bioresearch Center, 100 Research Dr, Worcester, MA 01605 USA
| | - Matthew Rosebraugh
- 3Clinical Pharmacology and Pharmacometrics, AbbVie, North Chicago, IL USA
| | - Neil Wishart
- 1Immunology Discovery Research, AbbVie Bioresearch Center, 100 Research Dr, Worcester, MA 01605 USA
| | - Lisa Olson
- 1Immunology Discovery Research, AbbVie Bioresearch Center, 100 Research Dr, Worcester, MA 01605 USA
| | - Andrew J Long
- 1Immunology Discovery Research, AbbVie Bioresearch Center, 100 Research Dr, Worcester, MA 01605 USA
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Abstract
Lipoma arborescens is a villous lipomatous proliferation of the synovial membrane characterized by chronic and painless synovial effusion. The aetiology is unknown. It has to be included in the differential diagnosis of chronic monoarticular disease in childhood. Magnetic resonance imaging provides a highly efficient tool for the diagnosis of this very rare condition. This is indeed the fourth paediatric case reported. Rather than resorting to the often inconvenient surgical synovectomy commonly recommended, we chose to treat the knee of this 13-yr-old boy with intra-articular osmic acid.
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Affiliation(s)
- J F Nisolle
- Department of Radiology, Louvain University (UCL) Hospital in Mont-Godinne, Belgium
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Abstract
We describe a case of pancreatic cystosis in an 18-year-old man suffering from cystic fibrosis, who presented with acute epigastric pain. Ultrasound and computed tomographic studies revealed multiple pancreatic cysts of various size, measuring up to 5 cm. Pancreatic macrocystosis is an extremely rare manifestation in cystic fibrosis.
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Affiliation(s)
- M E Cahill
- Department of Radiology, Clinique Saint Pierre, Ottignies, Belgium
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François P, Parmentier JM, Dardenne AN, Wese FX, Opsomer R, Abi Aad A, Van Cangh PJ. [Cholesteatoma of the upper urinary tract: endoscopic treatment]. Acta Urol Belg 1994; 62:21-3. [PMID: 7976850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report here on a case of cholesteatoma of the upper urinary tract. This rare, but recurrent disease was managed successfully by means of repeated endourological treatment. Diagnosis was confirmed by histological examination of samples obtained by percutaneous extraction.
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Affiliation(s)
- P François
- Service d'Urologie, Cliniques Universitaires St.-Luc, Université Catholique de Louvain
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