Janus kinase inhibitors and the risk of infections: a network meta-analysis across disease indications.

IF 3 3区医学 Q2 PHARMACOLOGY & PHARMACY

Expert Opinion on Drug Safety Pub Date : 2025-05-06 DOI:10.1080/14740338.2025.2502037

Xiaoqi Li, Qiaozhi Hu, Ting Xu

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引用次数: 0

Abstract

Introduction: To compare the risks of serious infections, herpes zoster (HZ), and opportunistic infections associated with Janus kinase (JAK) inhibitors versus placebo, tumor necrosis factor-α inhibitors (TNFi), methotrexate (MTX), and among different JAK inhibitors.

Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science databases from their inception until 23 January 2024. Network meta-analysis estimated odds ratios for infections using restricted maximum likelihood models.

Results: Eighty randomized controlled trials were included with 40,460 patients. Part of JAK inhibitors including tofacitinib (5 mg [2.01; 95%CI, 1.25-3.23], 10 mg [1.84; 95%CI, 1.06-3.17]), baricitinib (4 mg [1.57; 95%CI, 1.05-2.35]), and upadacitinib (15 mg [1.55; 95%CI, 1.06-2.27], 30 mg [1.94; 95%CI, 1.26-2.98]), exhibited a significantly different risk of serious infections compared to placebo. Similarly, tofacitinib (10 mg), baricitinib (4 mg), upadacitinib (15 mg, 30 mg), abrocitinib (200 mg), and peficitinib (100 mg) showed a significantly different risk of HZ infection compared to placebo. Most JAK inhibitors didn't raise opportunistic infections risks vs. TNFi and MTX, and risks among JAK inhibitors weren't statistically significant.

Conclusion: Attention should be paid to JAK inhibitor's types, dosages, and it is important to be aware of the risk of serious infections and HZ infections. Future long-term studies should be conducted.

Prospero: CRD42024523067.

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Janus激酶抑制剂和感染风险：跨疾病适应症的网络荟萃分析

简介：比较Janus激酶（JAK）抑制剂与安慰剂、肿瘤坏死因子-α抑制剂（TNFi）、甲氨蝶呤（MTX）和不同JAK抑制剂相关的严重感染、带状疱疹（HZ）和机会性感染的风险。方法：我们检索了PubMed、Embase、Cochrane Library和Web of Science数据库，从它们成立到2024年1月23日。网络荟萃分析使用限制最大似然模型估计感染的优势比。结果：纳入80项随机对照试验，40460例患者。部分JAK抑制剂包括托法替尼(5 mg [2.01；95%CI, 1.25-3.23], 10 mg [1.84；95%CI, 1.06-3.17])，巴西替尼(4 mg [1.57；95%CI, 1.05-2.35]), upadacitinib (15 mg [1.55；95%CI, 1.06-2.27], 30 mg [1.94；95%CI, 1.26-2.98])，与安慰剂相比，严重感染的风险有显著差异。同样，托法替尼（10mg）、巴西替尼（4mg）、upadacitinib （15mg、30mg）、abrocitinib （200mg）和非西替尼（100mg）与安慰剂相比，显示出显著不同的HZ感染风险。与TNFi和MTX相比，大多数JAK抑制剂不会增加机会性感染风险，JAK抑制剂之间的风险无统计学意义。结论：应注意JAK抑制剂的种类、用量，并注意严重感染和HZ感染的危险性。未来应进行长期研究。普洛斯彼罗:CRD42024523067。

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

Expert Opinion on Drug Safety 医学-药学

CiteScore

5.90

自引率

3.20%

发文量

审稿时长

6-12 weeks

期刊介绍： Expert Opinion on Drug Safety ranks #62 of 216 in the Pharmacology & Pharmacy category in the 2008 ISI Journal Citation Reports. Expert Opinion on Drug Safety (ISSN 1474-0338 [print], 1744-764X [electronic]) is a MEDLINE-indexed, peer-reviewed, international journal publishing review articles on all aspects of drug safety and original papers on the clinical implications of drug treatment safety issues, providing expert opinion on the scope for future development.