PMID- 33815570
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220421
IS  - 1759-720X (Print)
IS  - 1759-7218 (Electronic)
IS  - 1759-720X (Linking)
VI  - 13
DP  - 2021
TI  - Comparative efficacy and safety of Janus kinase inhibitors and biological 
      disease-modifying antirheumatic drugs in rheumatoid arthritis: a systematic 
      review and network meta-analysis.
PG  - 1759720X21999564
LID - 10.1177/1759720X21999564 [doi]
LID - 1759720X21999564
AB  - OBJECTIVE: To evaluate the comparative efficacy and safety of Janus kinase (JAK) 
      inhibitors and biological disease-modifying antirheumatic drugs (bDMARDs) in 
      patients with rheumatoid arthritis (RA) and an inadequate response to at least 
      one disease-modifying antirheumatic drug (DMARD). METHODS: PubMed, Embase, 
      Cochrane library and ClinicalTrials.gov were searched for relevant randomized 
      controlled trials (RCTs) from inception to April 2020. The active drugs included 
      three JAK inhibitors and eight bDMARDs while the control drugs included placebo 
      or conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). 
      Outcomes include American College of Rheumatology 20% response (ACR20), Disease 
      Activity Score in 28 joints (DAS28), Health Assessment Questionnaire-Disability 
      Index (HAQ-DI) and discontinuations for adverse events (AEs). We estimated 
      summary odds ratios (ORs) and weighted mean differences (WMDs) using network 
      meta-analysis with random effects. RESULTS: Eighty-eight RCTs with 31,566 
      patients were included. All JAK inhibitors and bDMARDs were more effective than 
      placebo in ACR20 (ORs ranging between 3.05 and 5.61), DAS28 (WMDs ranging between 
      -1.91 and -0.80) and HAQ-DI (WMDs ranging between -0.34 and -0.21). Tocilizumab, 
      certolizumab pegol and upadacitinib showed relatively good efficacy in these 
      three outcomes according to their relative ranking. Notably, tocilizumab was more 
      effective than other active drugs in DAS28 (WMDs ranging between -1.11 and 
      -0.49). Compared with the lower recommended doses, increasing the doses of JAK 
      inhibitors (baricitinib 4 mg versus 2 mg, tofacitinib 10 mg versus 5 mg and 
      upadacitinib 30 mg versus 15 mg) cannot provide significant additional benefits. 
      In terms of discontinuations for AEs, all active drugs showed no significant 
      difference compared with placebo except certolizumab pegol [OR 1.65, 95% credible 
      interval (CrI) 1.06-2.61] and rituximab (3.17, 1.11-10.80). CONCLUSIONS: 
      Tocilizumab, certolizumab pegol and upadacitinib may have relatively good 
      efficacy in patients with RA after treatment failure with csDMARDs. RA patients 
      taking a JAK inhibitor may have a preference for a lower recommended dose.
CI  - (c) The Author(s), 2021.
FAU - Weng, Chenghua
AU  - Weng C
AUID- ORCID: 0000-0001-7253-7745
AD  - Department of Rheumatology and Immunology, The Second Affiliated Hospital of 
      Soochow University, Suzhou, China.
FAU - Xue, Leixi
AU  - Xue L
AD  - Department of Rheumatology and Immunology, The Second Affiliated Hospital of 
      Soochow University, Suzhou, China.
FAU - Wang, Qing
AU  - Wang Q
AD  - Department of Rheumatology and Immunology, The Second Affiliated Hospital of 
      Soochow University, Suzhou, China.
FAU - Lu, Wentian
AU  - Lu W
AD  - Department of Rheumatology and Immunology, The Second Affiliated Hospital of 
      Soochow University, Suzhou, China.
FAU - Xu, Jiajun
AU  - Xu J
AD  - Department of Rheumatology and Immunology, The Second Affiliated Hospital of 
      Soochow University, Suzhou, China.
FAU - Liu, Zhichun
AU  - Liu Z
AD  - Department of Rheumatology and Immunology, The Second Affiliated Hospital of 
      Soochow University, Sanxiang Road No.1055, Suzhou, Jiangsu, 215000, P.R. China.
LA  - eng
PT  - Journal Article
DEP - 20210321
PL  - England
TA  - Ther Adv Musculoskelet Dis
JT  - Therapeutic advances in musculoskeletal disease
JID - 101517322
PMC - PMC7989112
OTO - NOTNLM
OT  - Janus kinase inhibitors
OT  - biological disease-modifying antirheumatic drugs
OT  - network meta-analysis
OT  - rheumatoid arthritis
COIS- Conflict of interest statement: The authors declare that there is no conflict of 
      interest.
EDAT- 2021/04/06 06:00
MHDA- 2021/04/06 06:01
PMCR- 2021/03/21
CRDT- 2021/04/05 05:59
PHST- 2020/12/18 00:00 [received]
PHST- 2021/02/01 00:00 [accepted]
PHST- 2021/04/05 05:59 [entrez]
PHST- 2021/04/06 06:00 [pubmed]
PHST- 2021/04/06 06:01 [medline]
PHST- 2021/03/21 00:00 [pmc-release]
AID - 10.1177_1759720X21999564 [pii]
AID - 10.1177/1759720X21999564 [doi]
PST - epublish
SO  - Ther Adv Musculoskelet Dis. 2021 Mar 21;13:1759720X21999564. doi: 
      10.1177/1759720X21999564. eCollection 2021.