Wang Faping, Tang Xiaoju, Zhu Min, Mao Hui, Wan Huajing, Luo Fengming
Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, China.
Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu 610041, China.
J Clin Med. 2022 Jul 30;11(15):4459. doi: 10.3390/jcm11154459.
Background: More and more trials have been conducted. We aimed to assess the efficacy and safety of different JAKinibs in RA. Methods: A systematic search of randomized controlled trials (RCTs) with JAKinib treatment in RA published in the Medline, Embase, and Cochrane databases up to May 2021 was performed. Results: 37 trials involving 15,174 patients were identified. Pooled analysis revealed that JAKinibs were associated with significant therapeutic improvement in RA patients as determined by ACR20 (RR = 2.03, 95% CI: 1.85 to 2.28) and HAQ-DI (MD = −0.31, 95% CI: −0.33 to −0.28) over placebo. Compared to placebo, JAKinib treatment was also associated with more adverse events (RR = 1.10, p < 0.001; RR = 1.29, p < 0.001; RR = 1.59, p = 0.02). Baricitinib and upadacitinib were related to more frequent adverse events (RR = 1.10; 95% CI: 1.01, 1.21; RR = 1.19; 95% CI: 1.11, 1.28) and infection (RR = 1.22; 95% CI: 1.09, 1.37; RR = 1.38; 95% CI: 1.22, 1.56), whereas only baricitinib was associated with more herpes zoster (RR = 3.15; 95% CI: 1.19, 8.33). Conclusions: JAKinibs were superior to placebo for improving signs, symptoms, and health-related quality of life in RA patients at short term, whereas the overall risk of adverse events and infections were greater with baricitinib and upadacitinib, and a higher risk of herpes zoster was only associated with baricitinib. More trials are needed to investigate the long-term safety.
已开展越来越多的试验。我们旨在评估不同JAK抑制剂在类风湿关节炎（RA）中的疗效和安全性。方法：对截至2021年5月在Medline、Embase和Cochrane数据库中发表的关于JAK抑制剂治疗RA的随机对照试验（RCT）进行系统检索。结果：共纳入37项试验，涉及15174例患者。汇总分析显示，与安慰剂相比，JAK抑制剂可使RA患者在ACR20（风险比[RR]=2.03，95%置信区间[CI]：1.85至2.28）和健康评估问卷残疾指数（HAQ-DI）（平均差[MD]=-0.31，95%CI：-0.33至-0.28）方面有显著的治疗改善。与安慰剂相比，JAK抑制剂治疗还与更多不良事件相关（RR=1.10，p<0.001；RR=1.29，p<0.001；RR=1.59，p=0.02）。巴瑞替尼和乌帕替尼与更频繁的不良事件（RR=1.10；95%CI：1.01，1.21；RR=1.19；95%CI：1.11，1.28）和感染（RR=1.22；95%CI：1.09，1.37；RR=1.38；95%CI：1.22，1.56）相关，而只有巴瑞替尼与更多带状疱疹相关（RR=3.15；95%CI：1.19，8.33）。结论：短期内，JAK抑制剂在改善RA患者的体征、症状和健康相关生活质量方面优于安慰剂，而巴瑞替尼和乌帕替尼的不良事件和感染总体风险更高，且只有巴瑞替尼与更高的带状疱疹风险相关。需要更多试验来研究长期安全性。
