Tian Cong, Shu Jianlong, Shao Wenhui, Zhou Zhengxin, Guo Huayang, Wang Jingang
Department of Traditional Chinese Medicine (TCM) Orthopedics & Traumatology, Funan Hospital of Traditional Chinese Medicine, Fuyang, China.
The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
Ann Transl Med. 2023 Feb 28;11(4):178. doi: 10.21037/atm-23-195.
Biologics and Janus kinase (JAK) inhibitors are commonly used to improve ankylosing spondylitis (AS) symptoms if conventional treatments are ineffective or unsuitable. This systematic review aimed to compare the therapeutic effects and safety of JAK inhibitors, tumor necrosis factor-alpha (TNF-α) inhibitors, and interleukin (IL) inhibitors in patients with AS.
We retrieved literature from various databases including Web of Science, Cochrane, Embase, PubMed, China National Knowledge Infrastructure, Weipu Journal Database, SinoMed, and WanFang Data up to February 1, 2023, and evaluated the quality of the included RCTs using the Cochrane risk-of-bias tool. R 4.1.3, STATA 15.1 were employed for network meta-analyses.
We identified 48 eligible articles including 8,937 patients. Ten articles were rated as "low risk", 5 as "high risk", and the others as "some concerns". In terms of efficacy, IL-17, IL-6, and JAK inhibitors were compared with TNF-α inhibitors in ASAS20 (RR =0.81, 95% CI: 0.66-0.98; RR =0.57, 95% CI: 0.35-0.95; RR =0.77, 95% CI: 0.60-0.99). IL-6 inhibitors were compared with TNF-α inhibitors in ASAS5/6 (RR =0.39, 95% CI: 0.16-0.98). IL-23, JAK inhibitors were compared with TNF-α inhibitors in BASDAI50 (RR =0.35, 95% CI: 0.20-0.60; RR =0.70, 95% CI: 0.49-0.98). IL-17 inhibitors were compared with IL-23 and IL-6 inhibitors in BASFI (MD =-1.05, 95% CI: -1.65--0.51; MD =-1.46, 95% CI: -2.02--0.97). In terms of safety, IL-6 inhibitors were compared with JAK, TNF-α inhibitors in AEs (RR =1.38, 95% CI: 1.06-1.88; RR =1.30, 95% CI: 1.01-1.70).
TNF-α inhibitors are significantly superior to both IL and JAK inhibitors, and may be the preferable option to deal with the rapid progression of AS and severe functional limitations. IL-17 inhibitors may better improve the BASDAI50 response compared with JAK, IL-23, and TNF-α inhibitors. The efficacy and safety of IL-6 inhibitors are inferior to other types of drugs, indicating the low efficacy and high risk of IL-6 inhibitors.
如果传统治疗无效或不适用，生物制剂和 Janus 激酶（JAK）抑制剂通常用于改善强直性脊柱炎（AS）症状。本系统评价旨在比较 JAK 抑制剂、肿瘤坏死因子-α（TNF-α）抑制剂和白细胞介素（IL）抑制剂对 AS 患者的治疗效果和安全性。
我们检索了截至 2023 年 2 月 1 日的多个数据库，包括 Web of Science、Cochrane、Embase、PubMed、中国知网、维普期刊数据库、中国生物医学文献数据库和万方数据，并使用 Cochrane 偏倚风险工具评估纳入的随机对照试验的质量。使用 R 4.1.3 和 STATA 15.1 进行网络荟萃分析。
我们确定了 48 篇符合条件的文章，共 8937 名患者。10 篇文章被评为“低风险”，5 篇为“高风险”，其他为“有些担忧”。在疗效方面，在 ASAS20 中比较了 IL-17、IL-6 和 JAK 抑制剂与 TNF-α 抑制剂（RR =0.81，95%CI：0.66 - 0.98；RR =0.57，95%CI：0.35 - 0.95；RR =0.77，95%CI：0.60 - 0.99）。在 ASAS5/6 中比较了 IL-6 抑制剂与 TNF-α 抑制剂（RR =0.39，95%CI：0.16 - 0.98）。在 BASDAI50 中比较了 IL-23、JAK 抑制剂与 TNF-α 抑制剂（RR =0.35，95%CI：0.20 - 0.60；RR =0.70，95%CI：0.49 - 0.98）。在 BASFI 中比较了 IL-17 抑制剂与 IL-23 和 IL-6 抑制剂（MD = -1.05，95%CI：-1.65 - -0.51；MD = -1.46，95%CI：-2.02 - -0.97）。在安全性方面，在不良事件中比较了 IL-6 抑制剂与 JAK、TNF-α 抑制剂（RR =1.38，95%CI：1.06 - 1.88；RR =1.30，95%CI：1.01 - 1.70）。
TNF-α 抑制剂明显优于 IL 和 JAK 抑制剂，可能是应对 AS 快速进展和严重功能受限的首选。与 JAK、IL-23 和 TNF-α 抑制剂相比，IL-17 抑制剂可能能更好地改善 BASDAI50 反应。IL-6 抑制剂的疗效和安全性低于其他类型药物，表明其疗效低且风险高。
