Witte Torsten
Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Z Rheumatol. 2022 Mar;81(2):94-99. doi: 10.1007/s00393-021-01125-w. Epub 2021 Nov 24.
In 2017 the first Janus kinase (JAK) inhibitors were approved for the treatment of rheumatoid arthritis in Germany. The mode of action of JAK inhibitors differs from biologicals, as multiple cytokines are inhibited. In comparison with the treatment with biologicals, JAK inhibitors have the advantage of oral application, three of the four currently approved JAK inhibitors were superior to adalimumab in at least some of the endpoints in randomized controlled trials, they have a short half-life and have a particular efficacy in the control of pain. On the other hand, the rate of malignancies and major cardiovascular events was increased in the Oral Surveillance trial in comparison with tofacitinib and tumor necrosis factor (TNF) inhibitors but not in the CorEvitas registry and not in the phase III approval trials. The clarification of these safety discussions and the evaluation of further registry data will decide the position of JAK inhibitors in the therapeutic algorithm for rheumatoid arthritis.
2017年，首批Janus激酶（JAK）抑制剂在德国获批用于治疗类风湿性关节炎。JAK抑制剂的作用方式与生物制剂不同，因为它能抑制多种细胞因子。与生物制剂治疗相比，JAK抑制剂具有口服给药的优势，目前获批的四种JAK抑制剂中有三种在随机对照试验的至少一些终点指标上优于阿达木单抗，它们半衰期短，在控制疼痛方面具有特殊疗效。另一方面，与托法替布和肿瘤坏死因子（TNF）抑制剂相比，口服监测试验中恶性肿瘤和主要心血管事件的发生率有所增加，但在CorEvitas注册研究和III期批准试验中并非如此。对这些安全性讨论的澄清以及对更多注册数据的评估将决定JAK抑制剂在类风湿性关节炎治疗方案中的地位。
