Anti-TNF vs. JAK Inhibitors: How Rheumatoid Arthritis Treatments Impact Coagulation Risks

According to a study published in the Journal of Clinical Rheumatology, both tumor necrosis factor blockers (anti-TNF) and Janus kinase inhibitors (JAKi) reduce the prothrombotic tendency in rheumatoid arthritis (RA) patients during the first 6 months of treatment.

The findings suggest a minimal risk of venous thromboembolism (VTE) with either therapy.

This longitudinal study assessed coagulation biomarkers—including D-dimer, fibrinogen, thrombin-antithrombin complex (TAT), and von Willebrand factor (vWF)—in 121 RA patients (mean age 57 years, 76% female). Patients were divided into anti-TNF (n=83) and JAKi (n=38) cohorts, with data collected at baseline and at 1, 3, and 6 months. Disease activity scores (DAS28-CRP) improved in both groups, reflecting effective treatment.

At baseline, coagulation marker levels were comparable between the groups. Anti-TNF users showed significant reductions in D-dimer (−0.31 mg/L, p=0.01) and fibrinogen (−0.71 g/L, p<0.001) over six months. However, TAT levels increased significantly (1.46 μg/L, p=0.03), with no effect on vWF. In the JAKi group, vWF declined significantly (−37.41%, p<0.001), while reductions in D-dimer, fibrinogen, and TAT were observed but did not reach statistical significance.

“The prothrombotic tendency in active RA declined during effective treatment with both anti-TNF and JAKi,” concluded the study authors. “Altogether, the biomarkers used in this study suggest that an increased VTE risk in the first 6 months due to either treatment with anti-TNF or JAKi is unlikely.”

Reference

Hansildaar R, Raadsen R, Gerritsen M, et al. Comparative analysis of coagulation activation in rheumatoid arthritis patients treated with TNF inhibitors versus JAK inhibitors: a prospective study. J Clin Rheumatol. Published