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Efficacy and Safety of Janus Kinase Inhibitors in the Treatment of Psoriasis and Psoriatic Arthritis: An Analysis of Evidence from 2014 to 2022
46 Pages Posted: 15 Mar 2023
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Efficacy and Safety of Janus Kinase Inhibitors in the Treatment of Psoriasis and Psoriatic Arthritis: An Analysis of Evidence from 2014 to 2022
Efficacy and Safety of Janus Kinase Inhibitors in the Treatment of Psoriasis and Psoriatic Arthritis: An Analysis of Evidence from 2014 to 2022
Abstract
Background: To date, the efficacy and safety of Janus kinase (JAK) inhibitors as novel therapies for psoriasis (PSO) and psoriatic arthritis (PsA) have not been systematically evaluated.
Methods: Randomized controlled studies (RCTs) assessing JAK inhibitors to treat PSO or PsA published before September 1, 2022, were searched in PubMed, Embase, and Cochrane Library databases. The Psoriasis Area and Severity Index (PASI) 75 and American College of Rheumatology (ACR) 50 were established as primary outcome indicators for PSO and PsA, respectively. Adverse events (AEs) were classified according to the eight systems of the human body.
Results: Herein, we included 16 relevant RCTs involving 4,936 patients with psoriasis, with interventions performed with different doses of JAK inhibitors. Except for one study, all used a placebo control. In three studies, JAK inhibitors were administered topically, whereas oral administration was performed in the remaining studies. Meta-analysis revealed that oral administration of JAK inhibitors significantly improved PASI 75 in patients with PSO (risk ratio [RR] 3.29; 95% confidence interval [CI] 2.37-4.57), and topical application was not effective (RR 1.45, 95% CI [0.97, 2.15]). JAK1 and JAK3 inhibitors were more effective than JAK1/JAK 2 inhibitors. JAK1 inhibitors afforded high response rates in improving ACR 50 in PsA (RR 8.00, 95% CI [3.61, 17.71]) and achieved significant results at 16 weeks of treatment (RR 2.95, 95% CI [1.63, 5.35]). AEs caused by JAK inhibitors were mainly related to the circulatory system (RR 3.09, 95% CI [1.42, 6.75]).
Conclusions: Oral, but not topical, JAK inhibitors could improve PASI scores in patients with PSO. Tofacitinib, a JAK1 and JAK3 inhibitor, exhibited a high response rate. The treatment effect peaked at 12 weeks. Filgotinib, a JAK1 inhibitor, markedly enhanced the response rate, improving the ACR scores in patients with PsA, and the best effect was achieved with a 16-week oral administration.
Funding: This work was sponsored by the National Natural Science Foundation of China (Nos. 82074427, 81874470), the Xinglin Scholar, Shanghai University of Traditional Chinese Medicine (No. RY411.14.12), and Science and Technology Commission of Shanghai Municipality (Nos.22Y11922200, 21Y21920102), and Shanghai Health Care Commission (Nos.20224Z0019).
Declaration of Interest: None declared.
Keywords: Janus Kinase (JAK) inhibitors, psoriasis (PSO), psoriatic arthritis (PsA), randomized controlled study, meta-analysis
Suggested Citation: Suggested Citation