Tofacitinib and Filgotinib is literally not approved and most likely will not be approved for Crohn's disease so what is the point of discussing the efficacy of these two drugs when there is Upadacitinib, a JAK-1 selective inhibitor, that has been approved for Crohn's.
Upadacitinib Induction and Maintenance Therapy for Crohn’s Disease | New England Journal of Medicine (nejm.org)
"A significantly higher percentage of patients who received 45-mg upadacitinib than those who received placebo had
clinical remission (in U-EXCEL, 49.5% vs. 29.1%; in
U-EXCEED, 38.9% vs. 21.1%) and an
endoscopic response (in U-EXCEL, 45.5% vs. 13.1%; in U-EXCEED, 34.6% vs. 3.5%) (P<0.001 for all comparisons).
At week 52 in U-ENDURE, a higher percentage of patients had clinical remission with 15-mg upadacitinib (37.3%) or 30-mg upadacitinib (47.6%) than with placebo (15.1%), and a higher percentage had an
endoscopic response with 15-mg upadacitinib (27.6%) or 30-mg upadacitinib (40.1%) than with placebo (7.3%) (P<0.001 for all comparisons)."
These are definitely some awesome looking results.
I'll also attach some statistics surrounding the "black box" warning applied on ALL JAKS because of data extrapolation from Tofacitinib (A JAK inhibitor that selectively inhibits Jak 3,1,2):
- Venous Thrombus Embolism: Incidence rates for Tofacitnib (33/10,000) vs TNF inhibitor (20/10,000).
- MACEs: Incidence rates for Tofacitnib (91/10,000) vs TNF inhibitor (73/10,000).
This is a negligible difference. Plus, these risk factors were mostly associated with patients older than 50 and with other comorbidities. Plus, the findings were mostly in those with rheumatoid arthritis, not IBD.
Waiting for JAK inhibitor safety data | RMD Open (bmj.com)
Safety of Janus Kinase Inhibitors in Inflammatory Bowel Diseases - PMC (nih.gov)