Department of Rheumatology, Medstar Washington Hospital Center, Washington, DC, USA.
Clin Rheumatol. 2018 Oct;37(10):2611-2620. doi: 10.1007/s10067-018-4199-7. Epub 2018 Jul 13.
Janus kinases (JAKs) play an important role in intracellular signaling for multiple cytokines in the pathogenesis of RA. Baricitinib is an oral, selective JAK 1 and 2 inhibitor which has been shown to be effective in the treatment of RA in several clinical trials. This meta-analysis aims to aggregate currently available data to assess the overall efficacy and safety of baricitinib in RA. We searched PubMed, EMBASE, and Cochrane CENTRAL from inception through 09/24/17 with restriction to English language. We excluded meeting abstracts without full text publication. We used RevMan 5.3 to perform meta-analysis between groups on baricitinib (2 and 4 mg daily) and placebo using random effect model calculating odds ratio (OR) as well as 95% confidence interval (CI). Compared to placebo, 2 mg of baricitinib was more effective in achieving ACR20 [54 vs. 36.6%; OR 2.09; 95% CI 1.60-2.71; p < 0.00001; I 0%], ACR50 [31.6 vs. 10.3%; OR 2.3; 95% CI 1.68-3.15; p < 0.00001; I 0%], and ACR70 responses [18.7 vs. 5.1%; OR 4.05; 95% CI 2.54-6.44; p < 0.00001; I 0%]. Similarly, 4 mg of baricitinib daily was more effective than placebo. Baricitinib 2 mg once daily did not increase any adverse events [65.3 vs. 62.4%; OR 1.03; 95% CI 0.80-1.34; p = 0.8; I 0%], serious adverse events [3.5 vs. 5%; OR 0.68; 95% CI 0.37-1.27; p = 0.22; I 0%], and herpes zoster [1.2 vs. 0.4%; OR 2.34; 95% CI 0.27-20.47; p = 0.44; I 37%] as compared to placebo. Similarly, 4 mg of baricitinib did not increase the risk of serious adverse events but increased herpes zoster infection [OR 3.88; 95% CI 1.36-11.06; p = 0.01; I 0%] when compared to placebo. Baricitinib is effective in treatment of RA, and did not appear to have significant safety concerns during the first 6 months of treatment.
Janus 激酶（JAKs）在类风湿关节炎（RA）发病机制中多种细胞因子的细胞内信号传导中发挥重要作用。巴瑞替尼是一种口服、选择性 JAK1 和 2 抑制剂，已在多项临床试验中被证实对 RA 具有治疗作用。本荟萃分析旨在汇总目前可用的数据，以评估巴瑞替尼在 RA 中的总体疗效和安全性。我们检索了 PubMed、EMBASE 和 Cochrane CENTRAL，从建库至 2017 年 9 月 24 日，仅限于英文文献。我们排除了没有全文发表的会议摘要。我们使用 RevMan 5.3 对巴瑞替尼（每日 2 和 4mg）和安慰剂组之间进行荟萃分析，采用随机效应模型计算比值比（OR）和 95%置信区间（CI）。与安慰剂相比，2mg 巴瑞替尼在实现 ACR20 方面更有效[54%比 36.6%；OR 2.09；95%CI 1.60-2.71；p<0.00001；I 0%]、ACR50[31.6%比 10.3%；OR 2.3；95%CI 1.68-3.15；p<0.00001；I 0%]和 ACR70 反应[18.7%比 5.1%；OR 4.05；95%CI 2.54-6.44；p<0.00001；I 0%]。同样，每日 4mg 巴瑞替尼也比安慰剂更有效。每日 2mg 巴瑞替尼并未增加任何不良反应[65.3%比 62.4%；OR 1.03；95%CI 0.80-1.34；p=0.8；I 0%]、严重不良反应[3.5%比 5%；OR 0.68；95%CI 0.37-1.27；p=0.22；I 0%]和带状疱疹[1.2%比 0.4%；OR 2.34；95%CI 0.27-20.47；p=0.44；I 37%]的发生。同样，4mg 巴瑞替尼并未增加严重不良反应的风险，但与安慰剂相比，带状疱疹感染的风险增加[OR 3.88；95%CI 1.36-11.06；p=0.01；I 0%]。巴瑞替尼治疗 RA 有效，在治疗的前 6 个月内似乎没有明显的安全性问题。
