[1]张春燕,范小冬,秦元,等.JAK抑制剂托法替布治疗类风湿性关节炎效果的Meta分析[J].第三军医大学学报,2018,40(06):543-550.
 ZHANG Chunyan,FAN Xiaodong,QIN Yuan,et al.Efficacy of Janus kinase inhibitor tofacitinib in treatment of rheumatoid arthritis: a meta-analysis[J].J Third Mil Med Univ,2018,40(06):543-550.
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第06期
页码:
543-550
栏目:
公共卫生与预防医学
出版日期:
2018-03-30

文章信息/Info

Title:
Efficacy of Janus kinase inhibitor tofacitinib in treatment of rheumatoid arthritis: a meta-analysis
作者:
张春燕范小冬秦元孔文强周春阳杜彪
川北医学院药学院;大理大学药学与化学学院;西南医科大学药学院;重庆三峡中心医院药学部
Author(s):
ZHANG Chunyan FAN Xiaodong QIN Yuan KONG Wenqiang ZHOU Chunyang DU Biao

School of Pharmacy, North Sichuan Medical College, Nanchong, Sichuan Province, 637000; College of Pharmacy and Chemistry, Dali University, Dali, Yunnan Province, 671000; School of Pharmacy, Southwest Medical University, Luzhou, Sichuan Province, 646000; Department of Pharmacy, Chongqing Three Gorges Central Hospital, Chongqing, 404000, China

关键词:
托法替布类风湿性关节炎Meta 分析
Keywords:
tofacitinib rheumatoid arthritis meta-analysis
分类号:
R181.23;R593.22;R977.3
文献标志码:
A
摘要:

目的    系统评价Janus激酶(JAK)抑制剂托法替布治疗类风湿性关节炎的有效性、安全性。方法    计算机检索PubMed、EMbase、The Cochrane Library(2017年8期)、Web of Science、CBM、万方数据库和CNKI数据库,搜集托法替布相关临床研究,检索时限均从建库至2017年6月1日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件对疗效指标、安全性指标进行疗效和安全性的Meta分析。结果    共纳入9个研究、3 742例患者。Meta分析结果显示:与安慰剂相比,托法替布剂量为5 mg或者10 mg,疗程为3个月或者6个月,在疗效指标美国风湿病学会改善标准ACR20、ACR50、ACR70反应率方面均优于安慰剂组,差异有统计学意义(P<0.05);在ACR20、ACR70反应率方面托法替布剂量为10 mg优于5 mg(P<0.05),在ACR50反应率方面两组之间差异无统计学意义(P>0.05)。安全性方面,托法替布增加除严重不良反应外的不良事件发生率和腹泻发生率(P<0.05)。结论     托法替布治疗类风湿性关节炎疗效较好,但轻微不良反应增多。

Abstract:

Objective     To systematically evaluate the efficacy and safety of Janus kinase (JAK) inhibitor, tofacitinib, in the treatment of rheumatoid arthritis. Method    sRandomized controlled trials (RCTs) about tofacitinib versus placebo in the treatment of rheumatoid arthritis were searched in PubMed, EMbase, the Cochrane Library (Issue 8, 2017), Web of Science, CBM, CNKI, and VIP databases from inception to June 1, 2017. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of eligible studies. Then meta-analysis of effective indexes such as the American College of Rheumatology 20% improvement criteria response rate (ACR20) and safety indexes such as serious adverse events were conducted by using RevMan 5.3 software. Results     A total of 9 RCTs involving 3 742 patients were included. The results of meta-analysis showed that: the ACR20, ACR50, ACR70 response rates of 5 mg or 10 mg tofacitinib group were higher than those of the placebo group no matter the treatment duration was 3 or 6 months (P<0.05). Tofacitinib 10 mg group was better than tofacitinib 5 mg group in the indexes of ACR20 and ACR70 (P<0.05), but there was no statistically difference between the 2 groups in the ACR50 reaction rate (P>0.05). On the safety, tofacitinib increased the incidence rate of adverse events and diarrhea than placebo (P<0.05), but had no difference in the rate of serious adverse events (P>0.05). Conclusion    Evidence shows that tofacitinib have considerable effect but with more mild adverse events in the treatment of rheumatoid arthritis.

参考文献/References:

[1]梁燕, 邹豪. 类风湿性关节炎药物治疗研究进展[J]. 海军医学杂志, 2014, 35(4):  332-333. DOI: 10.3969/j. issn.1009-0754.2014.04.041.
LIANG Y, ZOU H. Research progress for rheumatoid arthritis drugs[J]. J Navy Med, 2014, 35(4):  332-333. DOI: 10.3969/j. issn.10090754.2014.04.041.
[2]李瑞, 孟庆刚. 类风湿性关节炎的临床治疗研究[J]. 中华中医药学刊, 2007, 25(7):  1348-1352. DOI:  10.13193/j.archtcm.2007.07.38.lir.018.
LI R, MENG Q G. Clinic treating discussion of rheumatoid arthritis[J]. Chin Arch Tradit Chin Med, 2007, 25(7):  1348-1352. DOI:  10.13193/j.archtcm.2007.07.38.lir.018.
[3]胡晓敏, 宗英, 余珊珊, 等. 类风湿关节炎治疗药物的研发进展及趋势[J]. 中国新药杂志, 2017, 26(1):  36-43.
HU X M, ZONG Y, YU S S, et al. Research progress and trends in rheumatoid arthritis therapeutic drugs[J]. Chin J New Drug, 2017,26(1):  36-43.
[4]SMOLEN J S, LANDEW-R, BREEDVELD F C, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs:  2013 update [J]. Ann Rheum Dis, 2014,73(3): 492-509. DOI:  10.1136/annrheumdis-2013-204573.
[5]池里群, 周彬, 高文远, 等. 治疗类风湿性关节炎常用药物的研究进展[J]. 中国中药杂志, 2014, 39(15):  2851-2858. DOI: 10.4268/cjcmm20141512.
CHI L Q, ZHOU B, GAO W Y, et al. Research progress of drugs commonly used to anti-rheumatoid arthritis[J]. China J Chin Materia Med, 2014, 39(15):  28512858. DOI: 10.4268/cjcmm20141512.
[6]BANERJEE S, BIEHL A, GADINA M, et al. JAKSTAT signaling as a target for inflammatory and autoimmune diseases:  Current and future prospects[J]. Drugs, 2017, 77(5):  521-546. DOI: 10.1007/s40265-017-0701-9.
[7]VAN DER HEIJDE D1, TANAKA Y, FLEISCHMANN R, et al. Tofacitinib (CP-690,550) in patients with rheumatoid arthritis receiving methotrexate:  Twelve-month data from a twenty-four-month phase Ⅲ randomized radiographic study[J]. Arthritis Rheum, 2013, 65(3): 559-570. DOI:  10.1002/art.37816.
[8]FLEISCHMANN R, KREMER J, CUSH J, et al. Placebo-controlled trial of tofacitinib monotherapy in rheumatoid arthritis[J]. N Engl J Med, 2012, 367(6):  495-507. DOI: 10.1056/NEJMoa1109071.
[9]KREMER J, LI Z G, HALL S,et al. Tofacitinib in combination with nonbiologic diseasemodifying antirheumatic drugs in patients with active rheumatoid arthritis: a randomized trial[J]. Ann Intern Med,2013,159(4): 253-261. DOI:  10.7326/0003-4819-159-4-201308200-00006.
[10]KREMER J M, COHEN S, WILKINSON B E, et al. A phase IIb dose-ranging study of the oral JAK inhibitor tofacitinib (CP690,550) versus placebo in combination with background methotrexate in patients with active rheumatoid arthritis and an inadequate response to methotrexate alone[J]. Arthritis Rheum, 2012, 64(4):  970-981. DOI: 10.1002/art.33419.
[11]FLEISCHMANN R, CUTOLO M, GENOVESE M C, et al. Phase IIb dose-ranging study of the oral JAK inhibitor tofacitinib (CP690,550) or adalimumab monotherapy versus placebo in patients with active rheumatoid arthritis with an inadequate response to disease-modifying antirheumatic drugs[J]. Arthritis Rheum, 2012, 64(3):  617-629. DOI: 10.1002/art.33383.
[12]TANAKA Y, TAKEUCHI T, YAMANAKA H, et al. Efficacy and safety of tofacitinib as monotherapy in Japanese patients with active rheumatoid arthritis:  a 12-week, randomized, phase 2 study[J]. Mod Rheumatol, 2015, 25(4):  514-521. DOI: 10.3109/14397595.2014.995875.
[13]VAN VOLLENHOVEN R F, FLEISCHMANN R, COHEN S, et al. Tofacitinib or adalimumab versus placebo in rheumatoid arthritis[J]. N Engl J Med, 2012, 367(6):  508-519. DOI: 10.1056/NEJMoa1112072.
[14]BURMESTER G R, BLANCO R, CHARLES-SCHOEMAN C, et al. Tofacitinib (CP-690,550) in combination with methotrexate in patients with active rheumatoid arthritis with an inadequate response to tumour necrosis factor inhibitors:  a randomised phase 3 trial[J]. Lancet, 2013, 381(9865): 451-460. DOI:  10.1016/S0140-6736(12)61424-X.
[15]TANAKA Y, SUZUKI M, NAKAMURA H, et al. Phase Ⅱ study of tofacitinib (CP-690,550) combined with methotrexate in patients with rheumatoid arthritis and an inadequate response to methotrexate[J]. Arthritis Care Res (Hoboken), 2011, 63(8):  1150-1158. DOI:  10.1002/acr.20494.
[16]DARNELL J E JR, KERR I M, STARK G R, et al. JakSTAT pathways and transcriptional activation in response to IFNs and other extracellular signaling proteins [J]. Science,1994, 264(5164): 1415-1421.
[17]O’SHEA J J, PLENGE R. JAK and STAT signaling molecules in immunoregulation and immunemediated disease[J]. Immunity, 2012, 36(4):  542-550. DOI: 10.1016/j.immuni.2012.03.014.
[18]杨智, 张先龙. JAK3抑制剂托法替布治疗类风湿关节炎研究进展[J]. 国际骨科学杂志, 2013, 34(5):  326-328. DOI: 10.3969/j.issn.1673-7083.2013.05.006.
YANG Z, ZHANG X L. Research progress of JAK3 inhibitor tofacitinib on rheumatoid arthritis[J]. Int J Orthop, 2013, 34(5):  326-328. DOI: 10.3969/j.issn.1673-7083.2013.05.006.
[19]王士伟, 谭初兵, 徐为人. 新型类风湿关节炎治疗药物托法替尼[J]. 中国新药杂志,  2013(14):  1607-1609.
WANG S W, TAN C B, XU W R. Tofacitinib, a new drug for the treatment of rheumatoid arthritis[J]. Chin J New Drug, 2013(14):  1607-1609.
[20]刘雪涛, 李庆. 类风湿性关节炎治疗药物进展[J]. 现代生物医学进展, 2015, 15(6):  1171-1173. DOI:  10.13241/j.cnki.pmb.2015.06.043.
LIU X T, LI Q. Research Progress for Rheumatoid Arthritis Drugs[J]. Prog Mod Biomed, 2015, 15(6):  1171-1173. DOI:  10.13241/j.cnki.pmb.2015.06.043.
[21]中华医学会风湿病学分会. 类风湿关节炎诊断及治疗指南[J]. 中华风湿病学杂志, 2010, 14(4):  265-270. DOI: 10.3760/cma.j.issn.1007-7480.2010.04.014.
Chinese Rheumatology Branch of Chinese Medical Association. Rheumatoid arthritis diagnosis and treatment guidelines[J]. Chin J Rheumatol, 2010, 14(4):  265-270. DOI:10.3760/cma.j.issn.10077480.2010.04.014.
[22]BERGRATH E, GERBER R A, GRUBEN D, et al. Tofacitinib versus biologic treatments in moderateto-severe rheumatoid arthritis patients who have had an inadequate response to nonbiologic DMARDs:  systematic literature review and network meta-analysis[J]. Int J Rheumatol, 2017, 2017:  8417249. DOI: 10.1155/2017/8417249.

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更新日期/Last Update: 2018-03-23