Gastrointestinal perforation as a safety concern among patients with rheumatoid arthritis on Janus kinase inhibitor therapy: A systematic review and network meta-analysis.
Thipsukhon Sathapanasiri, Manuel Meraz, Hamraz Mokri, Sajesh Veettil, Karn Wijarnpreecha, Naomi Schlesinger, Arthur Kavanaugh, Nathorn Chaiyakunapruk
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引用次数: 0
Abstract
Objective: Gastrointestinal perforation (GIP) is a rare and life-threatening safety concern associated with Janus kinase inhibitors (JAKi). We aimed to review the evidence regarding the risk of GIP associated with the use of JAKi in patients with rheumatoid arthritis (RA) using a systematic review and network meta-analysis (NMA) approach.
Methods: A comprehensive literature search was conducted in PubMed, EMBASE, Cochrane CENTRAL, and ClinicalTrials.gov through August 2024. Included were randomized controlled trials (RCTs) comparing JAKi with other comparators in adult RA patients (age ≥ 18 years) and reports of GIP. Risk ratios (RR) with 95% confidence interval (CI) were estimated using a random-effects model. Surface under the cumulative ranking curves (SUCRA) were used to rank interventions.
Results: A total of 23 RCTs, involving 20,023 patients were included, with median follow-up time of 24 weeks. The overall incidence of GIP among JAKi-treated patients was 0.19% (95% CI: 0.10-0.35%), with 24 events occurring out of 12,430 patients. Pairwise meta-analysis showed that the risk of GIP among JAKi was not significantly increased compared to csDMARDs (RR = 1.02; 95% CI: 0.41-2.56; I2 = 0.0%). The results of the network meta-analysis are consistent with the pairwise meta-analysis finding. Compared to csDMARDs, there was no statistically significant increase in GIP risk with JAKi (RR 0.83; 95% CI: 0.37-1.84; p=0.64) with inconsistency (P=0.55). The SUCRA of JAKi (50.8%) and bDMARDs (77.0%) indicated a low risk of GIP.
Conclusion: JAK inhibitors were not associated with an increased risk of gastrointestinal perforation compared to csDMARDs in RA patients.
期刊介绍：
Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals (a division of the College), is a peer-reviewed publication that publishes original research, review articles, and editorials that promote excellence in the clinical practice of rheumatology. Relevant to the care of individuals with rheumatic diseases, major topics are evidence-based practice studies, clinical problems, practice guidelines, educational, social, and public health issues, health economics, health care policy, and future trends in rheumatology practice.
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