Janus kinase inhibitors versus tumor necrosis factor inhibitors in rheumatoid arthritis: meta-analytical comparison of efficacy and safety.

IF 4.6 2区医学 Q2 IMMUNOLOGY

Inflammopharmacology Pub Date : 2024-10-01 Epub Date: 2024-09-01 DOI:10.1007/s10787-024-01563-3

Mahmoud Kandeel, Mohamed A Morsy, Khalid M Alkhodair, Sameer Alhojaily

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Abstract

Background: 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.

Aim: 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).

Methods: 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.

Results: 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].

Conclusion: 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.

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类风湿关节炎中 Janus 激酶抑制剂与肿瘤坏死因子抑制剂的疗效和安全性荟萃分析比较。

背景：类风湿性关节炎（RA）是一种慢性全身性自身免疫性疾病，其特征是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）抑制剂在RA治疗中起着关键作用，但它们的疗效比较仍未得到充分探讨。目的：本研究旨在利用随机对照试验（RCTs）的数据，比较JAK抑制剂和TNF抑制剂治疗RA的疗效和安全性：方法：根据健康评估问卷残疾指数（HAQ-DI）、临床疾病活动指数（CDAI）、视觉模拟量表（VAS）和患者总体评估量表（PtGA）的结果以及静脉血栓栓塞（VTE）和恶性肿瘤的发病率等其他指标进行荟萃分析和结果分析：与 TNF 抑制剂相比，JAK 抑制剂能显著改善 HAQ-DI 评分[MD = 0.08，95% CI (0.03，0.12)，P = 0.0008]。然而，两类药物的CDAI评分无明显差异[MD = - 2.03，95% CI (- 9.27, 5.22)，p = 0.58]。JAK抑制剂与VAS评分的增加有关[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]：结论：与 TNF 抑制剂相比，JAK 抑制剂在改善 RA 患者的功能状态和减少疾病活动方面表现出更优越的疗效。虽然JAK抑制剂发生血栓栓塞的风险较高，但两类药物对VTE和恶性肿瘤的安全性相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Inflammopharmacology IMMUNOLOGYTOXICOLOGY-TOXICOLOGY

CiteScore

8.00

自引率

3.40%

发文量

200

期刊介绍： Inflammopharmacology is the official publication of the Gastrointestinal Section of the International Union of Basic and Clinical Pharmacology (IUPHAR) and the Hungarian Experimental and Clinical Pharmacology Society (HECPS). Inflammopharmacology publishes papers on all aspects of inflammation and its pharmacological control emphasizing comparisons of (a) different inflammatory states, and (b) the actions, therapeutic efficacy and safety of drugs employed in the treatment of inflammatory conditions. The comparative aspects of the types of inflammatory conditions include gastrointestinal disease (e.g. ulcerative colitis, Crohn''s disease), parasitic diseases, toxicological manifestations of the effects of drugs and environmental agents, arthritic conditions, and inflammatory effects of injury or aging on skeletal muscle. The journal has seven main interest areas: -Drug-Disease Interactions - Conditional Pharmacology - i.e. where the condition (disease or stress state) influences the therapeutic response and side (adverse) effects from anti-inflammatory drugs. Mechanisms of drug-disease and drug disease interactions and the role of different stress states -Rheumatology - particular emphasis on methods of measurement of clinical response effects of new agents, adverse effects from anti-rheumatic drugs -Gastroenterology - with particular emphasis on animal and human models, mechanisms of mucosal inflammation and ulceration and effects of novel and established anti-ulcer, anti-inflammatory agents, or antiparasitic agents -Neuro-Inflammation and Pain - model systems, pharmacology of new analgesic agents and mechanisms of neuro-inflammation and pain -Novel drugs, natural products and nutraceuticals - and their effects on inflammatory processes, especially where there are indications of novel modes action compared with conventional drugs e.g. NSAIDs -Muscle-immune interactions during inflammation [...]