Navigating JAKi Clinical Safety in Rheumatoid Arthritis

In collaboration with
Dr. Sanjay Dixit

We surveyed 21 Canadian Rheumatologists on:
  • use of JAK inhibitors (JAKi) for patients with moderate to severe rheumatoid arthritis (RA)
  • change in treatment algorithm given new clinical safety data

Rheumatologists surveyed see, on average, 126 patients over the 90 days prior to being surveyed. Of those, about 54% said they treat 100 or less moderate to severe RA patients.
Rheumatologists estimate around 39% of their patients have private coverage.

Connect with the KeyOps team to request a breakdown of private coverage.

Request a Demo
doctors animation
doctors animation

We partnered with Dr. Sanjay Dixit, an Ontario Rheumatologist, who has provided a reflection of his thoughts on the results throughout the final report.

"Most of the rheumatologists have responded in a way that is expected. I would have expected a higher number for Cimzia given its safety in pregnancy and data for monotherapy. I was also surprised to see 0 for Olumiant. Maybe a subset of questionnaires comparing all three JAKi and asking rheumatologists's choices and rationale for treatment decisions would be a great follow up to these insights."

40% of surveyed rheumatologists said efficacy was the most important factor, while 29% said safety.

When asked about changes to use of tofacitinib given more recent safety data disclosed, majority of physicians said they kept all existing patients on tofacitinib.

79% have kept all existing patients on tofacitinib, 7% said they stopped initiating high risk patients. 7% said they kept only low-risk patients on and moved high-risk patients to a new treatment. The final 7% said they stopped initiating any new patients regardless of risk profile.
Rheumatologists were presented with the following patient profile of Carla, a 45-year old female with RA.
*Verbatim were categorized into multiple categories in analysis. Request a copy of the report to see minority treatment selections and full comments.
  • Diagnosed 8 years ago
  • Non-smoker
  • Signs: 20 swollen and tender joints, and less able to enjoy normal activities
  • Family history: No cancer or heart attacks
  • Current medication: Methotrexate (20 mg per week), Hydroxychloroquine (400 mg daily) for three months Leflunomide (20 mg daily) with Hydroxychloroquine (400 mg daily) for three months
52% recommended treating with upadacitinib.
Why choose upadacitinib? 73% and the majority said safety, 55% said quick onset and 55% because it is an oral therapy.
trophy icon

KeyOps KOL Feature

stethascope icon
Dr. Matsos (ON, Rheumatologist) says:

"JAKi are first line choice in patients who are non responders to cDMARDs in my practice - oral is an option, if private coverage is easily obtainable, quick to act."

stethascope icon
Dr. Bardi (BC, Rheumatologist) says:

"Oral molecule that has once daily dosing with rapid onset of effect is the next preferred. On paper this has a better safety profile than tofacitinib."

stethascope icon
Rheumatologist feature: Dr. Appleton (ON, Rheumatologist)

Total equipoise: "There is no way to predict which treatment will work best/fastest for the patient. I often choose/recommend JAKi first as it is easier than a SC, but some patients are tired of pills too. In the absence of clear risk factors to choose for/against TNFi or JAKi, any of the above is a reasonable choice."

If Carla's same patient profile was presented, but only smoking status was changed only 14% would change their treatment.

Of those, 67% would switch to Cimzia due to safety concerns, and 33% would switch to a TNF biosimilar due to cardiovascular risk.

38% of Rheumatologists believe that the safety concern for tofacitinib was mainly due to the molecule itself. With the spread of responses, evaluation of causality is still being determined.

When surveyed about what they believe the safety concern is caused by, majority, which is 38% said it was due to the molecule itself. 24% said it was due to the way the trial was designed. 14% it was predictive of a class effect, while 10% said it was indicative of a class effect. Only 5% respectively said it was due to a class effect, related to the patient profile and existing risk factors or none of the mentioned options.

Rheumatologists stratify their patients based on a range of characteristics, but all agree on cardiovascular status as a common factor.

When asked about they stratify their patients, 100% agree on cardiovascular status. 86% said age and smoking status respectively. 81% said malignancy, and 5% said other.

For more information about other ailments Rheumatologists would use JAKi for in first line treatment, request a copy of the report:

Respondent profile


Male respondents


Clinic-based Practice


Average age


Average years in practice