Rheumatology:接受JAK抑制剂的类风湿关节炎患者发生严重感染的风险

2020-09-28 MedSci原创 MedSci原创

本项系统文献回顾和荟萃分析旨在评估接受JAK抑制剂的类风湿关节炎患者发生严重感染(SI)和带状疱疹(HZ)的风险,研究结果已在线发表于Rheumatology。

本项系统文献回顾和荟萃分析旨在评估接受JAK抑制剂的类风湿关节炎患者发生严重感染(SI)和带状疱疹(HZ)的风险,研究结果已在线发表于Rheumatology。

研究人员对托法替尼(5 mg bid)、巴利替尼(4 mg od)和奥帕西替尼(15 mg od)的II期和III期随机对照试验进行了系统文献回顾和荟萃分析。计算了患者暴露年限。应用每方案分析,纳入随机接受安慰剂的患者交叉进入治疗臂的随访时间。计算了每100人年SI和HZ的汇总发生率。采用元综合方法比较药物VS安慰剂的发生率比(IRRs)。

 

21项研究被纳入荟萃分析;11项托法替尼(5888名患者),6项巴里西尼(3520名患者)和4项厄达西尼研究(1736名患者)。对于SI,其发生率分别为1.97(95% CI:1.41,2.68)、3.16(95% CI:2.07,4.63)和3.02(95% CI:0.98,7.04)。治疗臂与安慰剂比较的IRRs在统计学上差异不显著:分别为1.22(95%CI:0.60,2.45)、0.80(95%CI:0.46,1.38)和1.14(95%CI:0.24,5.43)。对于HZ,其发生率分别为2.51(95%CI:1.87,3.30)、3.16(95%CI:2.07,4.63)和2.41(95%CI:0.66,6.18)。HZ较巴利替尼与安慰剂的IRR为2.86(95%CI:1.26,6.50)。与托法替尼和upadacitinib的IRR不显著:分别为1.38(95%CI:0.66,2.88)和0.78(95%CI:0.19,3.22)。不包括HZ的指标性机会性感染很少见,无法提供有意义的发生率。

综上所述,该结果表明,SI的绝对发生率很低。然而在整个JAK抑制剂中,HZ的发生率高于人群预期(3.23/100患者年)。虽然从数字上看,巴利替尼的风险最大,但药物之间的间接比较并未显示出任何明显的风险差异。

 

原始出处:

 

Katie BechmanSujith Subesinghe, et al., A systematic review and meta-analysis of infection risk with small molecule JAK inhibitors in rheumatoid arthritis. Rheumatology (Oxford). 2019 Oct 1;58(10):1755-1766. doi: 10.1093/rheumatology/kez087.

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    2022-06-22 屋顶瞄爱赏月

    签到学习

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    2021-09-27 13f0c37dm61暂无昵称

    good

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    2020-11-27 zhoujin4150

    托法替布还是比较安全

    0

  6. 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    2020-10-19 jklm09
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  8. 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    2020-09-30 lmm397
  9. 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AP&T: 定期使用质子泵抑制剂和女性类风湿性关节炎的风险

质子泵抑制剂(PPI)对肠道微生物组具有重要影响,进而可能增加类风湿关节炎(RA)的风险。本项研究旨在评估PPI的常规使用和RA的风险。

Am J Clin Nutr:类风湿关节炎的抗炎饮食(ADIRA)对疾病活动的影响

许多类风湿性关节炎(RA)患者报告说,某些食物可以缓解症状。早期的研究表明,食物和食物成分对RA的临床结果有积极的影响,但没有足够的证据提供具体的饮食建议。食物成分可能会相互作用,但缺乏评估联合效应的

Lancet:维持低剂量糖皮质激素治疗对低疾病活动度的类风湿关节炎患者症状控制更为有效

研究认为,对于使用托珠单抗和至少24周的糖皮质激素治疗达到低疾病活动度的类风湿关节炎患者,继续维持每天5mg的糖皮质激素治疗对疾病的控制效果优于逐渐减少糖皮质激素治疗方案

BMJ:不同生物药物联合甲氨蝶呤治疗类风湿关节炎的疗效差异研究

研究发现对于甲氨蝶呤治疗失败的类风湿关节炎患者,不同的生物药物与甲氨蝶呤联合用药仅在益处和危害方面存在细微差异