Bridging the Treatment Access Gap: Janus Kinase Inhibitors as First-line Advanced Therapy for Inflammatory Bowel Disease in Resource-variable Settings.

Aims and background: Janus kinase (JAK) inhibitors have reshaped the pharmacotherapeutic armamentarium for inflammatory bowel disease (IBD), distinguished by oral dosing, ambient-temperature stability, immunity from anti-drug antibody formation, and a characteristically brisk pharmacodynamic onset, properties that collectively set them apart from injectable biologic agents. The epidemiological footprint of IBD is expanding at an accelerating pace across Eastern Europe, Central Asia, and the Middle East, yet meaningful access to biologic therapies remains starkly uneven, constrained by coldchain dependencies, infusion-facility prerequisites, immunogenicity monitoring demands, and financial barriers. Prior reviews have been anchored to Western regulatory paradigms without examining the qualitatively distinct therapeutic roles JAK inhibitors could assume in resource-variable healthcare environments. This narrative review synthesizes comparative efficacy, tolerability, and logistical evidence for JAK inhibitors vs biologic agents and proposes a regionally grounded framework for their integration into the Euroasian IBD treatment pathway. Methods: A structured literature search of PubMed, MEDLINE, and the Cochrane Central Register of Controlled Trials was performed through March 2026, targeting randomized controlled trials (RCTs), network meta-analyses (NMAs), comparative effectiveness investigations, real-world cohort analyses, and contemporary clinical practice guidelines [American College of Gastroenterology (ACG) 2025, American Gastroenterological Association (AGA) 2024-2025, and European Crohn's and Colitis Organization (ECCO) 2025] addressing JAK inhibitors and biologic agents in moderate-to-severe ulcerative colitis (UC) and Crohn's disease (CD). Endpoints of interest spanned clinical remission, endoscopic improvement, histologic remission, rapidity of symptomatic relief, and safety parameters encompassing herpes zoster reactivation, major adverse cardiovascular events (MACE), and venous thromboembolism (VTE). Results: Multiple NMAs position upadacitinib at the apex for clinical remission induction in UC ( Conclusion: Within resource-variable Euroasian healthcare systems, JAK inhibitors may merit a substantially earlier position in the IBD treatment sequence than Western algorithms currently prescribe, by virtue of logistical attributes that circumvent the infrastructure constraints impeding biologic utilization. This review presents the first regionally anchored framework for deploying JAK inhibitors in clinical contexts where the operative decision is not between a JAK inhibitor and a biologic, but between a JAK inhibitor and the total absence of advanced therapy. Clinical significance: For gastroenterologists practicing throughout the Euroasian region under conditions of restricted biologic availability, limited infusion capacity, and absent therapeutic drug monitoring (TDM), this review furnishes an evidence-grounded rationale for deploying JAK inhibitors as first-line advanced therapy, supported by efficacy data, safety evidence, and pragmatic considerations tailored to resource-variable healthcare systems.