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Efficacy and safety of Janus kinase inhibitors in patients with psoriasis and psoriatic arthritis: a systematic review and meta-analysis

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Abstract

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.

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Data Availability

The data supporting the findings of this study are available within the article and its supplementary materials.

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Funding

This study was supported by the National Basic Research Program of China (973 Program) (No. 2014CB541801).

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Author notes

  1. Fan Yang and Chaofan Lu contributed equally to this study.

Authors and Affiliations

  1. Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Fan Yang, Chaofan Lu, Huilan Liu, Xiaomei Leng & Xiaofeng Zeng

  2. National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China

    Fan Yang, Chaofan Lu, Huilan Liu, Xiaomei Leng & Xiaofeng Zeng

  3. State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Beijing, China

    Fan Yang, Chaofan Lu, Huilan Liu, Xiaomei Leng & Xiaofeng Zeng

  4. Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China

    Fan Yang, Chaofan Lu, Huilan Liu, Xiaomei Leng & Xiaofeng Zeng

  5. Department of Epidemiology and Bio-Statistics, Institute of Basic Medical Sciences, China Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    Yanhong Wang

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Contributions

FY, XL, and XZ conceived the study and designed the protocol. FY and CL performed the literature search. FY and CL selected the studies and extracted the relevant information. FY and YW synthesized the data. FY wrote the first draft of the paper. All authors critically revised successive drafts of the paper and approved the final version. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

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Correspondence to Xiaomei Leng or Xiaofeng Zeng.

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Yang, F., Lu, C., Wang, Y. et al. Efficacy and safety of Janus kinase inhibitors in patients with psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Clin Rheumatol 42, 1593–1605 (2023). https://doi.org/10.1007/s10067-023-06529-4

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