Objective

One-third of patients with severe rheumatoid arthritis (RA) do not achieve remission or low disease activity, or they have side effects from cDMARD and bDMARD. They will need a new treatment option such as the small molecule JAK inhibitors. In this systematic review, we evaluate the efficacy and safety data of the current jakinibs: tofacitinib, peficitinib, decernotinib, upadacitinib, baricitinib and filgotinib in patients in whom treatment with conventional or biological disease-modifying antirheumatic drugs (cDMARD and/or bDMARD) failed.

Methods

We searched for randomized controlled trials comparing efficacy and safety of jakinibs for RA treatment using the Web of Science, Scopus, PubMed, and clinicaltrials.gov databases with the terms: “rheumatoid arthritis” OR “arthritis rheumatoid” OR “RA” AND “inhibitor” OR “jak inhibitor” AND “clinical trial” OR “treatment” OR “therapy”.

Results

All jakinibs achieved good results in ACR 20, 50, 70 and with CRP-DAS28 for LDA and remission, upadacitinib showed better results compared to the others. In ESR-DAS28 for remission, tofacitinib achieved the best result. Regarding the safety of all jakinibs, peficitinib, baricitinib and filgotinib did not register deaths in their studies unlike tofacitinib that presented 11 deaths. Despite all benefits of jakinibs, the use in patients with severe liver and kidney disease should be avoided.

Conclusions

Jakinibs in monotherapy or in combination with methotrexate can be considered a viable alternative in the treatment of moderate-to-severe RA. Even after failures with combination of cDMARDS and bDMARDS, jakinibs demonstrated efficacy.

中文翻译：

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当前用于治疗类风湿性关节炎的 jakinibs：系统评价

客观的

三分之一的严重类风湿性关节炎 (RA) 患者未达到缓解或疾病活动度低，或者出现 cDMARD 和 bDMARD 的副作用。他们将需要一种新的治疗选择，例如小分子 JAK 抑制剂。在本系统评价中，我们评估了当前雅克替尼：托法替尼、佩非替尼、地赛替尼、upadacitinib、巴瑞替尼和非戈替尼在常规或生物疾病缓解抗风湿药物（cDMARD 和/或 bDMARD）治疗失败的患者中的疗效和安全性数据.

方法

我们搜索了随机对照试验比较功效，并使用科学，SCOPUS，考研的网站为RA治疗jakinibs的安全性，并clinicaltrials.gov数据库用的术语：“类风湿性关节炎”或“类风湿关节炎”或“RA”和“抑制剂”或“jak 抑制剂”和“临床试验”或“治疗”或“治疗”。

结果

所有 jakinib 均在 ACR 20、50、70 和 CRP-DAS28 中获得了良好的结果，用于 LDA 和缓解，upadacitinib 与其他药物相比显示出更好的结果。在ESR-DAS28缓解中，托法替尼取得了最好的结果。关于所有 jakinib 的安全性，peficitinib、baricitinib 和 filgotinib 在他们的研究中没有登记死亡，与托法替尼不同的是，托法替尼有 11 人死亡。尽管 jakinibs 有所有好处，但应避免在患有严重肝肾疾病的患者中使用。

结论

Jakinibs 单药治疗或与甲氨蝶呤联合治疗可被视为治疗中重度 RA 的可行替代方案。即使在 cDMARDS 和 bDMARDS 组合失败后，jakinibs 也显示出疗效。