Department of Pharmacy, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
School of Medicine, Tongji University, Shanghai, China.
Front Immunol. 2022 Sep 29;13:977265. doi: 10.3389/fimmu.2022.977265. eCollection 2022.
We aim to evaluate the efficacy and tolerability of Janus kinase inhibitors (JAKi) as monotherapy and in combination with methotrexate (MTX) in active rheumatoid arthritis (RA).
Medline, EMBASE, and Cochrane Library were systematically searched to identify relevant randomized controlled trials (RCTs). Pooled analysis was conducted using random-effects model, along with the risk difference (RD) and 95% confidence intervals (CIs).
Three RCTs, including 2,290 patients, were included. JAKi (tofacitinib, baricitinib, and filgotinib) plus MTX displayed a higher proportion of patients meeting the American College of Rheumatology (ACR) criteria than JAKi alone at week 52 (ACR20 RD 0.032; 95% CI -0.027 to 0.091; ACR50 RD 0.050; 95% CI 0.003 to 0.097; ACR70 RD 0.056; 95% CI 0.012 to 0.100). Similar results were observed for ACR20/50/70 at week 24. No significant difference was found between two regimens for the proportion of patients achieving Health Assessment Questionnaire disability index (HAQ-DI) improvement ≥ 0.22 at weeks 24 and 52. Regarding low disease activity and remission achievement, JAKi in combination with MTX, contributed higher response rates than JAKi alone at weeks 24 and 52. Compared with JAKi monotherapy, combination therapy had a higher risks of treatment-emergent adverse events (TEAEs) and adverse events (AEs) leading to study discontinuation.
JAKi combined with MTX demonstrated superiority to JAKi monotherapy in terms of ACR responses, low disease activity and remission achievement. The two regimens presented comparable physical functioning measured by HAQ-DI improvement and similar tolerability, except for high risks of TEAEs and AEs leading to study discontinuation in combination therapy.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021288907.
我们旨在评估 Janus 激酶抑制剂（JAKi）作为单一疗法和与甲氨蝶呤（MTX）联合治疗活动性类风湿关节炎（RA）的疗效和耐受性。
系统检索了 Medline、EMBASE 和 Cochrane 图书馆，以确定相关的随机对照试验（RCT）。使用随机效应模型进行汇总分析，并采用风险差异（RD）和 95%置信区间（CI）。
纳入了三项 RCT，共 2290 名患者。JAKi（托法替尼、巴瑞替尼和菲戈替尼）联合 MTX 在第 52 周时达到美国风湿病学会（ACR）标准的患者比例高于 JAKi 单药治疗（ACR20 RD 0.032；95%CI-0.027 至 0.091；ACR50 RD 0.050；95%CI 0.003 至 0.097；ACR70 RD 0.056；95%CI 0.012 至 0.100）。在第 24 周时也观察到 ACR20/50/70 有类似的结果。在第 24 周和第 52 周时，两种方案达到健康评估问卷残疾指数（HAQ-DI）改善≥0.22的患者比例无显著差异。在低疾病活动度和缓解率方面，JAKi 联合 MTX 治疗在第 24 周和第 52 周时的应答率高于 JAKi 单药治疗。与 JAKi 单药治疗相比，联合治疗的治疗出现的不良事件（TEAEs）和导致研究终止的不良事件（AEs）风险更高。
JAKi 联合 MTX 在 ACR 反应、低疾病活动度和缓解率方面优于 JAKi 单药治疗。两种方案在 HAQ-DI 改善方面表现出相似的身体功能，并且具有相似的耐受性，除了联合治疗中 TEAEs 和 AEs 导致研究终止的风险较高外。
https://www.crd.york.ac.uk/PROSPERO/，标识符 CRD42021288907。
Zotero 插件
