类风湿关节炎患者中使用JAK抑制剂与TNF抑制剂的主要不良心血管事件和静脉血栓栓塞风险：一项系统评价和荟萃分析

Risk of Major Adverse Cardiovascular Events and Venous Thromboembolism with JAK Inhibitors versus TNF Inhibitors in Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis.

作者信息

Partalidou Styliani, Patoulias Dimitrios, Deuteraiou Kleopatra, Avgerou Paraskevi, Kitas George, Tzitiridou-Chatzopoulou Maria, Dimitroulas Theodoros

机构信息

1 Department of Internal Medicine, 424 Military Hospital of Thessaloniki, 56429, Thessaloniki, Greece.

Outpatient Department of Cardiometabolic Medicine, Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration", 54642 Thessaloniki, Greece.

出版信息

Mediterr J Rheumatol. 2024 Mar 30;35(Suppl 1):10-19. doi: 10.31138/mjr.171023.rof. eCollection 2024 Mar.

OBJECTIVE

The aim of this study was to compare the risk of major cardiovascular events (MACE) and venous thromboembolic events (VTE) between tumour necrosis factor (TNF) and Janus kinase (JAK) inhibitors in patients with rheumatoid arthritis (RA).

METHODS

We researched PubMed, Scopus, Cochrane Library, and clinicaltrials.gov until December of 2023 for randomised controlled trials (RCTs) and observational studies. The outcomes studied were MACE (stroke, heart attack, myocardial infarction, sudden cardiac death) and VTE (deep vein thrombosis, pulmonary embolism). We pooled data using random effects model. Risk for the reported outcomes was expressed as odds ratio (OR) with a 95% confidential interval (CI). We performed a subgroup analysis based on study design.

RESULTS

We identified 23 studies, 20 of which compared the odds for MACE and 14 the odds for VTE between JAK and TNF inhibitors in RA patients. Ten studies were RCTs and the rest were observational. Regarding MACE risk we pooled data from a total of 215,278 patients (52,243 were treated with JAK inhibitors, while the rest 163,035 were under TNF inhibitors). Compared with TNF inhibitors, the OR for JAK inhibitors in regards with MACE risk was 0.87 (0.64-1.17, p<0.01). Regarding VTE, a total of 176,951 patients were analysed (41,375 JAK inhibitors users and 135,576 TNF inhibitors users). The OR for VTE for JAK inhibitors compared with TNF inhibitors was 1.28 (0.89-1.84, p<0.01).

CONCLUSION

According to our results, there is no statistically significant difference for MACE or VTE in RA patients who receive either JAK or TNF inhibitors.

目的

本研究旨在比较类风湿关节炎（RA）患者中，肿瘤坏死因子（TNF）抑制剂和 Janus 激酶（JAK）抑制剂发生主要心血管事件（MACE）和静脉血栓栓塞事件（VTE）的风险。

方法

我们检索了 PubMed、Scopus、Cochrane 图书馆和 clinicaltrials.gov，截至 2023 年 12 月，查找随机对照试验（RCT）和观察性研究。研究的结局为 MACE（中风、心脏病发作、心肌梗死、心源性猝死）和 VTE（深静脉血栓形成、肺栓塞）。我们使用随机效应模型汇总数据。报告结局的风险以比值比（OR）表示，并伴有 95%置信区间（CI）。我们根据研究设计进行了亚组分析。

结果

我们确定了 23 项研究，其中 20 项比较了 RA 患者中 JAK 抑制剂和 TNF 抑制剂发生 MACE 的比值，14 项比较了发生 VTE 的比值。10 项研究为 RCT，其余为观察性研究。关于 MACE 风险，我们汇总了总共 215,278 名患者的数据（52,243 名接受 JAK 抑制剂治疗，其余 163,035 名接受 TNF 抑制剂治疗）。与 TNF 抑制剂相比，JAK 抑制剂发生 MACE 风险的 OR 为 0.87（0.64 - 1.17，p<0.01）。关于 VTE，总共分析了 176,951 名患者（41,375 名 JAK 抑制剂使用者和 135,576 名 TNF 抑制剂使用者）。与 TNF 抑制剂相比，JAK 抑制剂发生 VTE 的 OR 为 1.28（0.89 - 1.84，p<0.01）。