The choice between Janus kinase inhibitors (JAKi) and biologic drugs in rheumatoid arthritis remains a frequent question after failure of conventional therapy. Efficacy of these treatment classes appears similar in both randomized trials and real-world studies. The ORAL Surveillance study raised concerns regarding cardiovascular and oncological risks associated with JAKis in high-risk patients. However, data from international registries do not indicate an increased cardiovascular risk in real-word practice. Oncological data remains more heterogeneous. Treatment decisions should therefore be individualized, taking into account the patient's risk profile, preferences, and the risks associated with persistently uncontrolled inflammatory disease.
K. Lauper (2026) studied this question.