JAK-STAT controls the response of a cell to inflammatory signals and so drugs against the JAK-STAT players damp the symptoms which folks complain about to their consultant rheumatologists. But inflammation is a Good Thing, keeping pathogens and tumors at bay and dealing appropriately with tissue damage. Hence the litany of side effects outlined on the huge paper folded into the pill packet. This is why the rescue dog living with Pat the Salt is always sick: prednisolone, the corticosteroid used to treat her epilepsy, also prevents her inflammatory system from reacting to invasioners. Signalling pathways (all?) get a signal from a receptor at the cell membrane and send a message like a chinese whisper to the nucleus where all the genes (DNA) are bouncing up and down on the chromosome "pick me, pick me". The last step in the pathway is a transcription factor TF which makes that choice: TF-X will switch on gene-Y; it will transcribe its message as RNA (transcription); the RNA will leak out of the nucleus and make a protein which will have some usually useful effect. Plug the JAK-STAT pathway and you don't have that effect. That's good for your symptoms but also good for rogue viruses looking for a toe-hold. In deciding the optimal therapeutic regime, your pharmacist and your doctor are trying to balance the benefits against the damaging, debilitating side-effects. They are not trying to balance the budget, because neither of them are paying for the drugs they so easily prescribe and dispense.
It will help me if I here tabulate some of the suffixes which indicate what sort of drug you're taking or doling out to you aged parent (I had a previous essay on the naming conventions):
|-tinib||tyr-kinase inhibitor||Tofacitinib (above)|
|-mab||monoclonal antibody||Infliximab I|
|-iximab||chimeric antibody||Infliximab II|
|-izumab||humanised monoclonal antibody||natalizumab|
|-imumab||human monoclonal antibody||adalimumab|
Why am I talking to facitinib? Because one of my correspondents has been switched to it from same-old same-old so-yesterday Infliximab. Autoimmune diseases like psoriatic and rheumatoid arthritis are a penance you wouldn't wish on the parish's worst sinner. But the treatment is typically a) uncertain as to efficacy b) beset with unfortunate side effects and c) way beyond the pockets of a normal family who can't afford health insurance. Note that about half Ireland's population qualifies for a medical card, whereby The State is the insurance company. The bill for Tofacitinib is North of €2K/mo - up about 50% from infliximab which was the previous treatment of choice. Rumour has it that the Department of Health has over-spent its budget again this year. When it comes to fantastically expensive therapies [Orkambi or Factor VIII] or sexy-surgery like transplants and coronary by-passes or pretty much any treatment for people who have weeks to live then The Man just cannot say no. Sexual health education? depression? post-trauma physical rehab? drink awareness? prophylaxis? exercise? diet? incontinence and the pelvic floor? None of which shovel money at MegaPharma: They can all go sing for it.
No, you're welcome,
Bob the Tax-payer
Bob the Tax-payer