目的:本研究旨在评估JAK抑制剂治疗RA患者的有效性和安全性。
方法:CNKI数据库,VIP,万方,CBM,和PubMed,Embase,搜索Cochrane图书馆和WebofScience以确定相关的随机对照试验(RCT),从数据库创建到2024年4月。筛选,数据提取,和偏倚风险评估(使用ReviewManager-5.3软件)由至少两名作者独立进行.采用R4.1.3软件进行网络Meta分析。PROSPERO注册号:CRD4202237444。
结果:33个RCT包括15,961名患者,实验组涉及六种JAK抑制剂(filgotinib,托法替尼,decernotinib,baricitinib,upadacitinib和peficitinib)和12种干预措施(六种JAK抑制剂的不同剂量),对照组包括阿达木单抗(ADA)和安慰剂。与安慰剂相比,所有JAK抑制剂的疗效指标均显著提高(ACR20/50/70).与ADA相比,只有托法替尼,低剂量的decernotinib,和大剂量培非替尼显示ACR20/50/70显著增加.Decernotinib在ACR20/50/70的SUCRA排名中排名第一。在安全指标方面,只有低剂量菲格替尼和高剂量upadacitinib之间的差异,低剂量托法替尼和高剂量upadacitinib有统计学意义.低剂量菲尔戈替尼在SUCRA排名中排名第一,不良事件作为安全性指标。在不同的SUCRA排名中,只有托法替尼的疗效和安全性排名较高。
结论:六种JAK抑制剂的疗效优于安慰剂。在SUCRA中可以发现德克诺替尼的优异疗效和低剂量菲戈替尼的安全性。然而,不同的JAK抑制剂之间的安全性没有显着差异。头对头试验,直接相互比较,需要提供更多确定的证据。
OBJECTIVE: This study aims to evaluate the efficacy and safety of JAK inhibitors in the treatment of patients with RA.
METHODS: The databases CNKI, VIP, Wanfang, CBM, and PubMed, Embase, Cochrane Library and Web of Science were searched to identify relevant randomized controlled trials (RCTs), all from the time of database creation to April 2024. Screening, data extraction, and risk of bias assessment (using Review Manager-5.3 software) were independently performed by at least two authors. The network meta-analysis was conducted using R 4.1.3 software. PROSPERO registration number: CRD42022370444.
RESULTS: Thirty-three RCTs included 15,961 patients The experimental groups involved six JAK inhibitors (filgotinib, tofacitinib, decernotinib, baricitinib, upadacitinib and peficitinib) and 12 interventions (different doses of the six JAK inhibitors), and the control group involved adalimumab (ADA) and placebo. Compared with placebo, all JAK inhibitors showed a significant increase in efficacy measures (ACR20/50/70). Compared with ADA, only tofacitinib, low-dose decernotinib, and high-dose peficitinib showed a significant increase in ACR20/50/70. Decernotinib ranked first in the SUCRA ranking of ACR20/50/70. In terms of safety indicators, only those differences between low-dose filgotinib and high-dose upadacitinib, low-dose tofacitinib and high-dose upadacitinib were statistically significant. Low-dose filgotinib ranked first in the SUCRA ranking with adverse events as safety indicators. Only the efficacy and safety of tofacitinib ranked higher among different SUCRA rankings.
CONCLUSIONS: Six JAK inhibitors have better efficacy than placebo. The superior efficacy of decernotinib and safety of low-dose filgotinib can be found in the SUCRA. However, there are no significant differences in safety between the different JAK inhibitors. Head-to-head trials, directly comparing one against each other, are required to provide more certain evidence.