After two decades of research and development activity focussed on orally active 
kinase inhibitors, the first such drug (the JAK inhibitor Xeljanz, tofacitinib) 
was approved by the FDA in November 2012 for the treatment of rheumatoid 
arthritis (RA). There is an intense activity in many companies both on expanding 
the utility of JAK inhibitors in other auto-immune indications and in 
discovering inhibitors of the JAK family with different and more selective 
profiles. Progress is also being made with orally active Syk inhibitors. One 
such inhibitor (fostamatinib) is currently in large-scale phase 3 trials, and 
there are others in clinical development. The last two to three years have been 
transformative for kinase inhibitors in auto-immune diseases, as several 
inhibitors have finally progressed beyond phase 2 trials after so many failures 
on other targets. Thus, there are new treatment options for RA patients beyond 
existing oral DMARDs and parenteral biologics.