银屑病关节炎患者使用JAK抑制剂的主要不良心血管事件和血栓栓塞事件的风险：一项网络荟萃分析

IF 2.9 3区医学 Q2 RHEUMATOLOGY

Rheumatology and Therapy Pub Date : 2025-10-01 Epub Date: 2025-07-19 DOI:10.1007/s40744-025-00783-5

Lin-Hong Shi, James Cheng-Chung Wei, William Tao-Hsin Tung

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引用次数: 0

摘要

目的：我们的目的是通过网络荟萃分析（NMA）评估五种Janus激酶抑制剂（JAKis）与十种干预措施的比较效果，比较它们对银屑病关节炎（PsA）患者主要不良心血管事件（MACE）和血栓栓塞事件（TE）的影响。方法：我们对四个数据库进行了检索，检索时间从成立到2024年9月30日。我们还纳入了在患有PsA的成人（≥18岁）中比较JAKis与安慰剂或TNFi的研究。主要结局是MACE和TE的发生率。我们使用随机效应的网络元分析来估计总风险比（rr）。结果：11项研究符合入选标准。综合RCT和LTE数据显示，MACE和TE事件分别为23例和26例，MACE和TE的发病率（IR）分别为0.25和0.29 / 100人年。在所有的RCT数据中，有12例MACE和8例TE事件，MACE和TE的ir分别为0.62和0.41 / 100人年。在符合条件的随机对照试验中，与安慰剂相比，托法替尼（5mg和10mg）和upadacitinib （30mg）与较低的TE风险相关（GRADE确定性分别为中度、中度和高）。与阿达利单抗相比，RCT/LTE数据显示，upadacitinib （15mg和30mg）与MACE风险降低相关（GRADE确定性分别为中度和中度）。结论：托法替尼和upadacitinib在MACE和TE风险方面优于安慰剂，与阿达木单抗相当，即使长期暴露，这可能是PsA治疗中积极考虑的因素。新的研究性JAKis的心血管安全性需要进一步验证。

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Risk of Major Adverse Cardiovascular Events and Thromboembolism Events in Patients with Psoriatic Arthritis on JAK Inhibitors: A Network Meta-Analysis.

Objectives: Our objective was to evaluate the comparative effects of five Janus kinase inhibitors (JAKis) with ten interventions, comparing their impact on major adverse cardiovascular events (MACE) and thromboembolism events (TE) in patients with psoriatic arthritis (PsA) through network meta-analysis (NMA).

Methods: We conducted a search across four databases from inception to September 30, 2024. We also included studies comparing JAKis with placebo or TNFi in adults (≥ 18 years) with PsA. The primary outcomes were the incidence of MACE and TE. We used network meta-analysis with random effects to estimate summary risk ratios (RRs).

Results: Eleven studies met the eligibility criteria. Combined RCT and LTE data showed 23 MACE and 26 TE events, with incidence rates (IR) of 0.25 and 0.29 per 100 person-years for MACE and TE, respectively. Across all RCT data, there were 12 MACE and 8 TE events, with IRs of 0.62 and 0.41 per 100 person-years for MACE and TE, respectively. In eligible RCTs, tofacitinib (5 mg and 10 mg) and upadacitinib (30 mg) were associated with a lower risk of TE compared to placebo (GRADE certainty: moderate, moderate, and high, respectively). Compared to adalimumab, upadacitinib (15 mg and 30 mg) was associated with a decreased risk of MACE in RCT/LTE data (GRADE certainty: moderate and moderate, respectively).

Conclusions: Tofacitinib and upadacitinib are superior to placebo and comparable to adalimumab regarding MACE and TE risk, even with long-term exposure, which may be positively considered in PsA treatment. The cardiovascular safety of new investigational JAKis needs further validation.

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来源期刊

Rheumatology and Therapy RHEUMATOLOGY-

CiteScore

6.00

自引率

5.30%

发文量

审稿时长

6 weeks

期刊介绍： Aims and Scope Rheumatology and Therapy is an international, open access, peer reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world and health outcomes research around the discovery, development, and use of rheumatologic therapies. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also welcomed. Areas of focus include, but are not limited to, rheumatoid arthritis, gout, gouty arthritis, psoriatic arthritis, osteoarthritis, juvenile idiopathic/rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis, Pompe’s disease, inflammatory joint conditions, musculoskeletal conditions, systemic sclerosis, and fibromyalgia. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, case reports, trial protocols, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Rheumatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research. Ethics and Disclosures The journal is a member of the Committee on Publication Ethics (COPE) and subscribes to its principles on how to deal with acts of misconduct thereby committing to investigate allegations of misconduct in order to ensure the integrity of research. Content in this journal is peer-reviewed (Single-blind). 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