开始RA治疗 - 生物药物还是JAK抑制剂?
Roberto Caporali1, Sabino Germinario1, Dorottya Kacsándi2
1Department of Clinical Sciences and Community Health, University of Milan and ASST G. Pini-CTO, Milan, Italy.
Autoimmunity reviews
|August 27, 2023
概括
雅努斯激酶抑制剂 (JAKi) 提供口服高级治疗类风湿性关节炎 (RA),与生物药物相当. 然而,安全问题需要仔细选择患者和共享决策,以获得最佳的JAK抑制剂使用.
科学领域:
- 类风湿病学 类风湿病学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 简氏激酶抑制剂 (JAKi) 代表了风湿性关节炎 (RA) 口服治疗的重大进步,其疗效与生物药物相当.
- 最近的口服监测试验的安全数据引起了人们对与JAK抑制剂托法西提尼布相关的心血管不良事件和恶性瘤的担忧.
研究的目的:
- 评估JAK抑制剂在风湿性关节炎治疗中的不断变化的作用.
- 为解决围绕使用JAK抑制剂作为一线先进治疗选择的争议.
- 根据RA管理中JAK抑制剂的适当使用情况,为临床决策提供信息.
主要方法:
- 对临床试验数据的审查,包括口腔监测试验.
- 对JAK抑制剂与TNF抑制剂 (TNFi) 的安全性和有效性概况的分析.
- 考虑监管警告和专家风湿病学家的意见.
主要成果:
- 雅克抑制剂的疗效与生物制剂相当,但具有潜在的安全风险,特别是心血管和恶性瘤问题,正如最近的试验数据所强调的那样.
- 监管机构发布了警告,影响了JAK抑制剂的感知和使用.
- 生物制剂的成本效益,特别是生物类似剂的可用性,提供了一个替代的视角.
结论:
- 在RA中使用JAK抑制剂是一个复杂的决定,平衡有效性与安全性问题,特别是在高风险患者中.
- 临床医生和患者之间的共同决策对于适当的JAK抑制剂选择至关重要.
- 对于特定的RA患者群体来说,JAK抑制剂仍然是一个有价值的选择,特别是当口服更好或TNFi是禁忌时.
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