Janus kinase inhibitors for psoriatic arthritis: Evidence from a systematic review and network meta-analysis

Psoriatic arthritis (PsA) constitutes a heterogeneous disease. Diagnosis is commonly made by identifying joint inflammation, dactylitis, enthesitis, or axial spine involvement in cutaneous or nail psoriasis. Janus kinases (JAKs) are intracellular kinases that mediate cytokine signaling. The present network meta-analysis aimed to provide a comprehensive summary regarding the use of JAK inhibitors (JAKis) in PsA. We systematically searched MEDLINE, CENTRAL, Web of Science databases, and the clinicaltrials.gov registry until October 2023 and included randomized controlled trials (RCTs). Examined outcomes consisted of the proportion of participants achieving ACR20, ACR50, ACR70, PASI75, resolution of enthesitis, resolution of dactylitis, and experiencing serious adverse events (SAEs). Changes in the Health Assessment Questionnaire Disability Index (HAQ-DI) from the baseline were also recorded. The revised Cochrane Risk of Bias 2.0 tool determined the risk of bias. Networks were constructed, and random-effects frequentist analyses were employed utilizing the placebo arms from each study. Most JAKis were superior to placebo for all examined outcomes. Statistical advantages of one JAKi over another were recorded, and all concerned upadacitinib. However, the safety profile of upadacitinib did not differ significantly from that of other JAKis. Our network meta-analysis is the first to concentrate on comparable, current outcome data of JAKis in PsA on clinical efficacy. It reveals statistically significant variations in the advantages and disadvantages among JAKis in PsA, which require further meticulous assessment.