Meta-analysis Of Efficacy And Safety Of JAK Inhibitors In The Treatment Of Psoriatic Arthritis

Objective:The efficacy and safety of Janus kinase(JAK)inhibitors in the treatment of psoriatic arthritis(Ps A)by a meta-analysis system was evaluated.Methods:The computer system searches the Pub Med,EMbase,Cochrane Library databases,the randomized controlled trial(RCT)articles associated with JAK inhibitor treatment for Ps A were searched until 01 March 2023.According to the exclusion criteria,the final data were collected and collated,and the quality of Cochrane risk bias assessment tool was evaluated.Finally,Rev Man 5.4 and Stata17.0 analysis were used to calculate the efficacy and safety of JAK inhibitors in Ps A.Results:A total of 7 studies with 2220 samples were finally included.(1)Results of traditional meta-analysis: ACR 20 [RR=2.02,95% CI:(1.83,2.23),P<0.00001],ACR50[RR=3.11,95% CI:(2.18,4.45),P<0.00001],ACR70[RR=4.56,95% CI:(2.43,8.54),P<0.00001],PASI75[RR=2.78,95% CI:(2.31,3.34),P<0.00001],MDA[RR=3.34,95% CI:(2.64,4.23),P <0.00001] were all better than those of the control group,The incidence of AE and SAE did not prove that the test group was better than the control group.(2)Reticular meta-analysis: 1)The league table results showed that the four JAK inhibitors were superior to placebo in ACR 20,ACR 50,ACR 70,and PASI75,only three JAK inhibitors were included in MDA,Tofacitinib,Deucravacitinib and Updacitinib were superior to placebo,Deucravacitinib was higher than placebo in terms of AE incidence,and the results of SAE incidence did not support a statistically significant difference between JAK inhibitors and placebo.2)SUCUR probability ranking result:(1)ACR20 SUCRA probability ranking is Filgotinib(85.8%)> Updacitinib(70.1%)>Tofacitinib(54.0%)> Deucravacitinib(39.6%)> placebo(0.5%);(2)ACR50 SUCRA The probability ranking is Updacitinib(78.5%)> Filgotinib(62.2%)> Tofacitinib(58.3%)>Deucravacitinib(46.8%)> placebo(4.1%);(3)ACR70 SUCRA The probability ranking is Updacitinib(80.1%)> Deucravacitinib(78.7%)> Filgotinib(51.7%)> Tofacitinib(38.1%)> placebo(1.4%);(4)PASI75 SUCRA The probability ranking is Updacitinib(80.7%)> Filgotinib(73.4%)> Tofacitinib(50.3%)> Deucravacitinib(45.5%)> placebo(0.2%);(5)MDA SUCRA The probability ranking is Tofacitinib(87.0%)>Deucravacitinib(57.4%)> Updacitinib(55.2%)> placebo(0.4%);(6)AE SUCRA The probability ranking was Filgotinib(28.3%)<placebo(29.1%)<Tofacitinib(47.5%)<Updacitinib(48.3%)<Deucravacitinib(96.8%);(7)SAE SUCRA The probability ranking was Filgotinib(13.3%)<Tofacitinib(28.5%)<placebo(48.9%)<Updacitinib(70.7%)<Deucravacitinib(88.7%).Conclusions:The results of the conventional meta-analysis indicated that JAK inhibitors were superior to placebo in efficacy and not different from placebo in safety.According to the results of the mesh meta-analysis,different JAK inhibitors are better than placebo in terms of effectiveness in treating Ps A.Filgotinib is the relatively best choice among the four interventions,and Deucravacitinib is the worst safe of the four JAK inhibitors.However,in clinical practice,individual selection should be made according to the different needs and states of patients.Given the limitations of this study,the conclusion needs to be verified by more high-quality studies.