Department of Medicine, Houston Methodist Research Institute, Houston, TX, United States of America.
Department of Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, United States of America.
PLoS One. 2024 Jul 31;19(7):e0306548. doi: 10.1371/journal.pone.0306548. eCollection 2024.
Patients with rheumatoid arthritis (RA) who receive immunosuppressive medications have a heightened risk of infection. The goal of our study was to calculate the pooled cumulative incidence and risk of infection in patients with RA treated with Janus kinase inhibitors (JAKi). The PubMed and EMBASE databases were queried for randomized controlled trials comparing patients with RA treated with JAKi (upadacitinib, baricitinib, tofacitinib, peficitinib, or filgotinib), defined as the treatment group, compared with control subjects, defined as participants receiving placebo or treatment regimen that was similar to that of participants in the treatment group, with the exception of JAKi. The primary study endpoint was the relative risk (RR) of any-grade and severe infection. The secondary endpoints were RR and cumulative incidence of opportunistic infections, herpes zoster, and pneumonia. The Stata v17 software was used for all data analysis. Results showed that treatment with baricitinib was associated with an increased risk of any-grade (RR 1.34; 95% CI: 1.19-1.52) and opportunistic (RR 2.69; 95% CI: 1.22-5.94) infection, whereas treatment with filgotinib (RR 1.21; 95% CI: 1.05-1.39), peficitinib (RR 1.40; 95% CI: 1.05-1.86) and upadacitinib (RR 1.30; 95% CI: 1.09-1.56) was associated with increased risk of any-grade infection only. Analysis based on type of infection showed a pooled cumulative incidence of 32.44% for any-grade infections, 2.02% for severe infections, 1.74% for opportunistic infections, 1.56% for herpes zoster, and 0.49% for pneumonia in patients treated with any JAKi during the follow-up period. Treatment with specific JAKi in patients with RA is associated with an increased risk of any-grade and opportunistic infections but not severe infection. Close clinical monitoring of patients with RA treated with JAKi is required to establish the long-term infection risk profile of these agents.
类风湿关节炎（RA）患者接受免疫抑制药物治疗会增加感染的风险。我们的研究目的是计算接受 Janus 激酶抑制剂（JAKi）治疗的 RA 患者的累积感染发生率和感染风险。我们在 PubMed 和 EMBASE 数据库中检索了比较接受 JAKi（upadacitinib、baricitinib、tofacitinib、peficitinib 或 filgotinib）治疗的 RA 患者（定义为治疗组）与接受安慰剂或与治疗组参与者相似的治疗方案（除 JAKi 外）的对照组患者的随机对照试验。主要研究终点是任何级别和严重感染的相对风险（RR）。次要终点是机会性感染、带状疱疹和肺炎的 RR 和累积发生率。所有数据分析均使用 Stata v17 软件。结果表明，baricitinib 治疗与任何级别（RR 1.34；95%CI：1.19-1.52）和机会性（RR 2.69；95%CI：1.22-5.94）感染风险增加相关，而 filgotinib（RR 1.21；95%CI：1.05-1.39）、peficitinib（RR 1.40；95%CI：1.05-1.86）和 upadacitinib（RR 1.30；95%CI：1.09-1.56）治疗与任何级别感染风险增加相关。基于感染类型的分析显示，在随访期间接受任何 JAKi 治疗的患者的任何级别感染累积发生率为 32.44%，严重感染发生率为 2.02%，机会性感染发生率为 1.74%，带状疱疹发生率为 1.56%，肺炎发生率为 0.49%。RA 患者使用特定的 JAKi 治疗与任何级别和机会性感染风险增加相关，但与严重感染无关。需要密切监测接受 JAKi 治疗的 RA 患者，以确定这些药物的长期感染风险特征。
