Management Of Immune-mediated Diseases Research Articles

Examining the Safety Profile of Janus Kinase (JAK) Inhibitors in the Management of Immune-Mediated Diseases: A Comprehensive Review.

Janus kinase (JAK) inhibitors have heralded a paradigm shift in the management of immune-mediated diseases. While their efficacy is well-established, the safety concerns associated with these agents, particularly regarding thromboembolic events (TE), remain a focus of extensive research and clinical scrutiny. This comprehensive literature review embarks on an exploration of the multifaceted landscape of JAK inhibitors, providing insights into their safety profiles across diverse immune-mediated diseases. The introduction highlights the transformative influence of JAK inhibitors in the treatment of immune-mediated diseases. Historically, the therapeutic arsenal for these conditions included corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biologics. The advent of JAK inhibitors has revolutionized this landscape, although concerns about their safety persist. This review strives to comprehensively evaluate their safety, amalgamating knowledge from multiple studies and trials. The subsequent sections delve into the safety of specific JAK inhibitors in the context of rheumatoid arthritis, inflammatory bowel diseases, and dermatologic conditions and their associations with venous thromboembolism. The evolving understanding of TE risk, particularly the intricate relationship between these agents and immune-mediated diseases, is meticulously unravelled. The concluding remarks underscore the dynamic nature of TE risk assessment with regard to immune-mediated diseases involving JAK inhibitors. It underscores that risk assessment is multifactorial, influenced not only by the choice of JAK inhibitor but also by the nuances of the underlying immune-mediated disease and the unique patient characteristics. This review offers a holistic perspective on TE risks associated with JAK inhibitors and contributes to the ongoing dialogue regarding their safety in the realm of immune-mediated diseases.

Assessment of secondary immunodeficiency – the role of laboratory testing

Clinical immunology is in a historically significant phase of escalation of targeted immunotherapeutics that will continue to transform the management of immune mediated diseases. Each of these novel agents manipulates the immune system in different ways with adverse events including a spectrum of opportunistic infections, malignancies and paradoxical inflammatory reactions. A key clinical challenge for prescribers at the bedside is the selection and titration of the most suitable agents for maximum benefit and minimum toxicity. In this context, it is worth reviewing what has been achieved to date in measuring the functional immune reserve in an individual patient. At the simplest level immunodeficiency can be characterised by the susceptibility to infection. This approach presents two problems. First, infections are a universal experience of otherwise healthy individuals, and second, the prevention of episodes of infection is a key clinical ambition. Conventional immunopathology tests may provide data to help identify which patients are at greatest risk of immunosuppression complications, but when critically appraised, fall short of what is required in practice. This paper will review current laboratory approaches to assessing secondary immunodeficiency and will highlight the need for immunopathology laboratories to adapt to the new therapeutic opportunities.

Glucocorticosteroids as immunosuppressive agents.

When administered at pharmacological dosages, glucocorticosteroid hormones alter leukocyte kinetics, phagocytic cell function, cell-mediated immunity, and, to a lesser extent, humoral immunity. These properties are used to advantage in the treatment of immunologically mediated disease. Corticosteroids are used to suppress pathological immune responses associated with autoimmunity, inhibit rejection of allogenic tissues after organ transplantation, and to diminish inflammation associated with a wide variety of hypersensitivity disorders. The mechanisms by which corticosteroids relieve these conditions are still not completely understood but have recently become more comprehensible. By understanding how corticosteroids exert their effects, we can make better clinical decisions in the management of immune-mediated disease.