Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Korea (Republic of).
Z Rheumatol. 2024 Feb;83(Suppl 1):88-96. doi: 10.1007/s00393-022-01165-w. Epub 2022 Feb 10.
The relative remission rates of tofacitinib, baricitinib, upadacitinib, and filgotinib compared with those of adalimumab were assessed in patients with rheumatoid arthritis (RA) who responded poorly to methotrexate (MTX).
We performed a Bayesian network meta-analysis to combine direct and indirect evidence from randomized controlled trials (RCTs) to examine the Disease Activity Score in 28 joints with C‑reactive protein (DAS28-CRP), the Clinical Disease Activity Index (CDAI), the Simplified Disease Activity Index (SDAI), and the Boolean remission of tofacitinib, baricitinib, upadacitinib, filgotinib, and adalimumab in RA patients with inadequate responses to MTX.
Four RCTs, comprising 3507 patients, met the inclusion criteria. The filgotinib 200 mg + MTX and upadacitinib 15 mg + MTX groups showed a significantly higher DAS28-CRP < 2.6 than adalimumab 40 mg + MTX. Upadacitinib 15 mg + MTX showed a significantly higher CDAI (≤ 2.8) than adalimumab 40 mg + MTX (odds ratio [OR]: 1.62; 95% credible interval [CrI]: 1.16-2.29). The ranking probability based on the surface under the cumulative ranking curve (SUCRA) indicated that upadacitinib 15 mg + MTX had the highest probability of being the best treatment as it achieved a CDAI ≤ 2.8, followed by filgotinib 200 mg + MTX, baricitinib 4 mg + MTX, tofacitinib 5 mg + MTX, and adalimumab 40 mg + MTX. The Boolean remission showed the same distribution pattern as that of the CDAI ≤ 2.8. Upadacitinib 15 mg + MTX showed a significantly higher SDAI ≤ 3.3 than adalimumab 40 mg + MTX (OR: 1.62; 95% CrI: 1.16-2.28). SUCRA ranking based on SDAI ≤ 3.3 indicated that upadacitinib 15 mg + MTX had the highest probability of being the best treatment for achieving an SDAI ≤ 3.3, followed by baricitinib 4 mg + MTX, filgotinib 200 mg + MTX, tofacitinib 5 mg + MTX, and adalimumab 40 mg + MTX.
In RA patients with an inadequate response to MTX, remission rates with JAK inhibitors were significantly higher; there is evidence for differences in efficacy regarding remission among the different JAK inhibitors.
评估托法替布、巴瑞替尼、乌帕替尼和氟可替尼与阿达木单抗相比，在对甲氨蝶呤（MTX）反应不佳的类风湿关节炎（RA）患者中的相对缓解率。
我们进行了贝叶斯网络荟萃分析，将来自随机对照试验（RCT）的直接和间接证据结合起来，以检查 DAS28-CRP、CDAI、SDAI 中托法替布、巴瑞替尼、乌帕替尼、氟可替尼和阿达木单抗的疗效，这些疗效在对 MTX 反应不足的 RA 患者中得到了评估。
四项 RCT 共纳入 3507 例患者，符合纳入标准。与阿达木单抗 40mg+MTX 相比，氟可替尼 200mg+MTX 和乌帕替尼 15mg+MTX 组的 DAS28-CRP<2.6 显著更高。与阿达木单抗 40mg+MTX 相比，乌帕替尼 15mg+MTX 组的 CDAI（≤2.8）显著更高（比值比[OR]：1.62；95%可信区间[CrI]：1.16-2.29）。基于累积排序曲线下面积（SUCRA）的表面下概率（排名概率）表明，乌帕替尼 15mg+MTX 作为最佳治疗方案的可能性最高，因为它达到了 CDAI≤2.8，其次是氟可替尼 200mg+MTX、巴瑞替尼 4mg+MTX、托法替布 5mg+MTX 和阿达木单抗 40mg+MTX。布尔缓解与 CDAI≤2.8 的分布模式相同。与阿达木单抗 40mg+MTX 相比，乌帕替尼 15mg+MTX 的 SDAI≤3.3 显著更高（OR：1.62；95% CrI：1.16-2.28）。基于 SDAI≤3.3 的 SUCRA 排名表明，乌帕替尼 15mg+MTX 作为最佳治疗方案的可能性最高，其次是巴瑞替尼 4mg+MTX、氟可替尼 200mg+MTX、托法替布 5mg+MTX 和阿达木单抗 40mg+MTX。
在对 MTX 反应不足的 RA 患者中，JAK 抑制剂的缓解率显著更高；不同 JAK 抑制剂在缓解方面的疗效存在差异。
