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Efficacy and Safety of JAK Inhibitors for Rheumatoid Arthritis: A Meta-Analysis

Faping Wang1,2, Xiaoju Tang1,2, Min Zhu1,2

  • 1Laboratory of Pulmonary Immunology and Inflammation, Department of Respiratory and Critical Care Medicine, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, China.

Journal of Clinical Medicine
|August 12, 2022
PubMed

Insights

Janus kinase inhibitors (JAKinibs) effectively improve rheumatoid arthritis (RA) symptoms and quality of life compared to placebo. However, JAKinibs, particularly baricitinib and upadacitinib, are linked to increased adverse events and infections.

Area of Science:

  • Rheumatology
  • Pharmacology
  • Clinical Trials

Background:

  • Rheumatoid arthritis (RA) management increasingly utilizes Janus kinase inhibitors (JAKinibs).
  • A comprehensive assessment of JAKinib efficacy and safety in RA is warranted due to numerous ongoing trials.

Purpose of the Study:

  • To systematically evaluate the efficacy and safety of various JAKinibs in patients with rheumatoid arthritis.
  • To compare the therapeutic benefits and adverse event profiles of JAKinibs against placebo and among different JAKinib agents.

Main Methods:

  • A systematic literature search was conducted across Medline, Embase, and Cochrane databases up to May 2021.
  • Included were randomized controlled trials (RCTs) investigating JAKinib treatment for RA.
  • Pooled analysis of data from 37 trials involving 15,174 patients was performed.

Main Results:

  • JAKinibs demonstrated significant improvements in RA patient outcomes, including ACR20 response (RR = 2.03) and Health Assessment Questionnaire Disability Index (HAQ-DI) scores (MD = -0.31) compared to placebo.
  • JAKinib treatment was associated with a higher incidence of adverse events (RR = 1.10 to 1.59) and infections (RR = 1.22 to 1.38) versus placebo.
  • Baricitinib and upadacitinib showed increased risks of adverse events and infections, while baricitinib alone was linked to a higher risk of herpes zoster (RR = 3.15).

Conclusions:

  • JAKinibs offer short-term superiority over placebo in improving RA signs, symptoms, and quality of life.
  • Baricitinib and upadacitinib are associated with greater risks of overall adverse events and infections.
  • Further research is necessary to ascertain the long-term safety profile of JAKinibs in RA management.
Keywords:
JAKinhibitorsmeta-analysisrheumatoid arthritissystematic review

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