Background: The cardiovascular safety of JAK inhibitors (JAKi) remains a contentious topic, as evidenced by the ORAL surveillance study, which found JAKi use not non-inferior to biologic therapy for major adverse cardiovascular events (MACE) in older rheumatoid arthritis patients with cardiovascular risk factor. Generalising these findings is challenging due to patient and JAKi characteristics. This narrative review aimed to clarify JAKi’s cardiovascular risk by summarising relevant literature.

Objectives: This narrative review aimed to clarify JAKi’s cardiovascular risk by summarising relevant literature.

Methods: A search of The Cochrane Library and Ovid MEDLINE from inception to 2023 using keywords related to JAKi, rheumatic disease, and MACE was performed. English language studies of adults with autoimmune inflammatory arthritis who received JAKi and mentioned descriptive MACE or explored the potential role of JAKi in the pathophysiology of cardiovascular disease were included.

Results: 95 articles met inclusion criteria. Factors like smoking history, advanced age, and cardiovascular disease history were associated with increased MACE. However, JAKi class, dose, combination therapy, patient ethnicity and rheumatic disease type didn’t strongly alter cardiovascular risk.

Conclusion: Intrinsic JAKi features (class and dose) showed no robust association with MACE. However, JAKi might contribute to MACE in patients with advanced age, smoking status, and cardiovascular history. Long-term, large population studies are needed to better characterise the cardiovascular risk of JAKi.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: Alexander Kwan: None declared, Elvina Ingrid: None declared, Matthew Jiang: None declared, Keith Lim Janssen Pharmaceuticals research grant.