PMID- 36763226 OWN - NLM STAT- MEDLINE DCOM- 20230524 LR - 20230524 IS - 1434-9949 (Electronic) IS - 0770-3198 (Linking) VI - 42 IP - 6 DP - 2023 Jun TI - Efficacy and safety of Janus kinase inhibitors in patients with psoriasis and psoriatic arthritis: a systematic review and meta-analysis. PG - 1593-1605 LID - 10.1007/s10067-023-06529-4 [doi] AB - OBJECTIVES: To evaluate the efficacy and safety of Janus kinase (JAK) inhibitors (Jakinibs) in the treatment of psoriasis and psoriatic arthritis (PsA). METHODS: Databases including PubMed, Embase, Web of Science, and Cochrane Library were searched for randomized controlled trials on the efficacy and safety of Jakinibs in treating psoriasis and PsA from inception to July 2021. A systematic review and meta-analysis were performed to estimate pooled relative risk (RR) and 95% confidence interval (CI). RESULTS: Seventeen clinical trials (16 publications) comprising 6802 patients were included. All Jakinibs demonstrated significantly higher response rates compared with placebo (ACR20: RR 2.09, 95% CI 1.90-2.30; PASI75: RR 4.03, 95% CI 3.13-5.18). Within the subgroup analysis, the response rates defined by ACR20 were highest for filgotinib (RR 2.40, 95% CI 1.67-3.45), followed by upadacitinib, tofacitinib, and deucravacitinib. The proportion of patients achieving PASI75 response in the tofacitinib 10 mg twice daily group was significantly higher than that in the tofacitinib 5 mg group. Regarding safety, the incidence of adverse events (AEs) was significantly higher for Jakinibs compared with placebo (RR 1.17, 95% CI 1.11-1.23). Of note, a considerable increase in the risk of infections including upper respiratory tract and herpes zoster infection was observed among patients in the treatment group. For tofacitinib, upadacitinib, and filgotiniband, infection was the most prevalent AE. Moreover, AEs in the 10 mg tofacitinib group were higher than those in the 5 mg tofacitinib group. CONCLUSION: Jakinibs are efficacious interventions for the treatment of psoriasis and PsA, but they are associated with an increased risk of AEs when compared with placebo. The long-term efficacy and safety data require further evaluation. Key Points * This systematic review investigated and compared the efficacy and safety of different Jakinibs including the novel selective TYK2 inhibitors. * Jakinibs are efficacious interventions for the treatment of psoriasis and PsA. * A relatively higher dosing schedule of Jakinibs is associated with increased toxicity. CI - (c) 2023. The Author(s), under exclusive licence to International League of Associations for Rheumatology (ILAR). FAU - Yang, Fan AU - Yang F AD - Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China. AD - National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China. AD - State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China. AD - Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. FAU - Lu, Chaofan AU - Lu C AD - Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China. AD - National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China. AD - State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China. AD - Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. FAU - Wang, Yanhong AU - Wang Y AD - Department of Epidemiology and Bio-Statistics, Institute of Basic Medical Sciences, China Academy of Medical Sciences & Peking Union Medical College, Beijing, China. FAU - Liu, Huilan AU - Liu H AD - Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China. AD - National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China. AD - State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China. AD - Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. FAU - Leng, Xiaomei AU - Leng X AUID- ORCID: 0000-0002-0215-9176 AD - Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China. lpumch@126.com. AD - National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China. lpumch@126.com. AD - State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China. lpumch@126.com. AD - Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. lpumch@126.com. FAU - Zeng, Xiaofeng AU - Zeng X AD - Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China. xiaofeng.zeng@cstar.org.cn. AD - National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China. xiaofeng.zeng@cstar.org.cn. AD - State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China. xiaofeng.zeng@cstar.org.cn. AD - Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China. xiaofeng.zeng@cstar.org.cn. LA - eng PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20230210 PL - Germany TA - Clin Rheumatol JT - Clinical rheumatology JID - 8211469 RN - 0 (Janus Kinase Inhibitors) SB - IM MH - Humans MH - *Arthritis, Psoriatic/drug therapy MH - *Janus Kinase Inhibitors/adverse effects MH - *Psoriasis/drug therapy/chemically induced MH - Incidence MH - Treatment Outcome OTO - NOTNLM OT - JAK inhibitors OT - Psoriasis OT - Psoriatic arthritis OT - Systematic review OT - TYK2 inhibitors EDAT- 2023/02/11 06:00 MHDA- 2023/05/24 06:42 CRDT- 2023/02/10 11:19 PHST- 2022/06/14 00:00 [received] PHST- 2023/01/28 00:00 [accepted] PHST- 2022/11/30 00:00 [revised] PHST- 2023/05/24 06:42 [medline] PHST- 2023/02/11 06:00 [pubmed] PHST- 2023/02/10 11:19 [entrez] AID - 10.1007/s10067-023-06529-4 [pii] AID - 10.1007/s10067-023-06529-4 [doi] PST - ppublish SO - Clin Rheumatol. 2023 Jun;42(6):1593-1605. doi: 10.1007/s10067-023-06529-4. Epub 2023 Feb 10.