Department of Biomedical Sciences, College of Veterinary Medicine, King Faisal University, 31982, Al-Ahsa, Saudi Arabia.
Department of Pharmacology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, 33516, Egypt.
Inflammopharmacology. 2024 Oct;32(5):3229-3246. doi: 10.1007/s10787-024-01563-3. Epub 2024 Sep 1.
Rheumatoid arthritis (RA) is a chronic systemic autoimmune disorder characterized by persistent inflammation leading to progressively worse disability. Janus kinase (JAK) inhibitors and tumor necrosis factor (TNF) inhibitors are pivotal in RA treatment, yet their comparative efficacy remains underexplored.
This study aimed to compare the efficacy and safety of JAK inhibitors and TNF inhibitors in treating RA using data from randomized controlled trials (RCTs).
A meta-analysis and outcomes analysis were based on results of the Health Assessment Questionnaire Disability Index (HAQ-DI), Clinical Disease Activity Index (CDAI), Visual Analogue Scale (VAS), and Patient Global Assessment Scale (PtGA) and other indices as incidences of venous thromboembolism (VTE) and malignancy.
The JAK inhibitors caused a statistically significant improvement in the HAQ-DI score [MD = 0.08, 95% CI (0.03, 0.12), p = 0.0008] compared with the TNF inhibitors. However, no significant difference was observed between the two drug classes in the CDAI score [MD = - 2.03, 95% CI (- 9.27, 5.22), p = 0.58]. JAK inhibitors were associated with an increase in the VAS score [MD = 3.62, 95% CI (0.86, 6.38), p = 0.01], but there was no significant difference in the PtGA score [MD = 1.91, 95% CI (- 3.25, 7.08), p = 0.47].
JAK inhibitors demonstrated superior efficacy in improving the functional status and reducing the disease activity in RA patients compared with TNF inhibitors. Both drug classes exhibited comparable safety profiles for VTE and malignancies, though JAK inhibitors had a higher risk for thromboembolism.
类风湿关节炎（RA）是一种慢性系统性自身免疫性疾病，其特征为持续性炎症，导致残疾程度逐渐加重。Janus 激酶（JAK）抑制剂和肿瘤坏死因子（TNF）抑制剂是 RA 治疗的关键药物，但它们的疗效比较仍未得到充分探索。
本研究旨在通过随机对照试验（RCT）的数据，比较 JAK 抑制剂和 TNF 抑制剂治疗 RA 的疗效和安全性。
采用荟萃分析和结局分析方法，比较 JAK 抑制剂和 TNF 抑制剂对 HAQ-DI 评分、CDAI 评分、VAS 评分和 PtGA 评分等指标的改善作用，同时比较静脉血栓栓塞症（VTE）和恶性肿瘤发生率等安全性指标。
与 TNF 抑制剂相比，JAK 抑制剂可显著改善 HAQ-DI 评分[MD=0.08，95%CI（0.03，0.12），p=0.0008]。然而，两种药物类别在 CDAI 评分方面没有显著差异[MD=-2.03，95%CI（-9.27，5.22），p=0.58]。JAK 抑制剂与 VAS 评分的升高相关[MD=3.62，95%CI（0.86，6.38），p=0.01]，但在 PtGA 评分方面没有显著差异[MD=1.91，95%CI（-3.25，7.08），p=0.47]。
与 TNF 抑制剂相比，JAK 抑制剂在改善 RA 患者的功能状态和降低疾病活动度方面表现出更好的疗效。两种药物类别在 VTE 和恶性肿瘤方面具有相似的安全性特征，但 JAK 抑制剂的血栓栓塞风险更高。
