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Performance of Janus kinase inhibitors in psoriatic arthritis with axial involvement in indirect comparison with ankylosing spondylitis: a retrospective analysis from pooled data

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Abstract

Background and objective

As the well-acknowledged autoimmune disease, Janus kinase (JAK) is thought to play important roles in the progression of tissue injury in spondyloarthropathy. From a current perspective, JAK inhibitors could be applied to both psoriatic arthritis (PsA) and ankylosing spondylitis (AS). Nonetheless, it is reasonable to doubt whether PsA and AS differentially respond to JAK inhibitors.

Methods

Different databases were searched for full-text publication based on inclusion and exclusion criteria. For data-pooling, a fixed-effect model was applied if heterogeneity was not detected. All results of the analysis were illustrated as forest plots. Publication bias was assessed using Begg’s adjusted rank correlation test. The standard mean difference (SMD) was calculated in continuous variables. The pooled odds ratio was calculated in categorical variables.

Results

Nine clinical studies were finally included with a 3-month follow-up. The efficacy and safety of JAK inhibitors were comprehensively investigated. JAK inhibitors were proved to be effectively improving disease condition within 3 months (12 weeks) in both PsA and AS. Besides, psoriasis-related dermal lesions could also be improved by JAK inhibitors. Dose-dependent effects suggested that higher dose tofacitinib could bring not only a higher level of treatment response but also more safety concerns.

Conclusion

JAK inhibitors were proved to be effective in improving arthritis symptoms and enhancing the quality of life in both PsA and AS patients. Compared with AS, JAK inhibitors seemed to perform better in PsA treatment. However, the frequency of adverse events PsA and AS in comparison with the placebo group showed no difference. Higher dose of tofacitinib could attain better treatment response without increasing adverse events in short-term follow-up.

Key Points:

• JAK inhibitors were proved to be effective in improving arthritis symptoms and enhancing the quality of life in both PsA and AS patients.

• Compared with AS, JAK inhibitors seemed to perform better in PsA treatment.

• The frequency of adverse events PsA and AS in comparison with the placebo group showed no difference.

• Higher dose of tofacitinib could attain better treatment response without increasing adverse events in short-term follow-up.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

PsA:

psoriatic arthritis

Pso:

psoriasis

AS:

ankylosing spondylitis

JAK:

Janus kinase

DMARDs:

disease-modifying antirheumatic drugs

OR:

odds ratio

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

SMD:

standard mean difference

QoL:

quality of life

HLA-B27:

human leukocyte antigen-B27

CI:

confidence interval

ACR:

American College of Rheumatology

ASAS:

The Assessment of SpondyloArthritis international Society

PASI:

The Psoriasis Area and Severity Index

HAQ-DI:

Health Assessment Questionnaire-Disability Index

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Author notes

  1. Lin Wang and Xiaofang Ping contributed equally to this work.

Authors and Affiliations

  1. Department of Dermatology, the Fifth Central Hospital of Tianjin, No. 41 Zhejiang Road, Tianjin, 300450, China

    Lin Wang, Xiaofang Ping, Wei Chen & Weibin Xing

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  1. Lin Wang
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  2. Xiaofang Ping
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  3. Wei Chen
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Contributions

LW and WX contributed to the study conception and design. All authors collected the data and performed the data analysis. All authors contributed to the interpretation of the data and the completion of figures and tables. All authors contributed to the drafting of the article and final approval of the submitted version.

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Correspondence to Weibin Xing.

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Supplemental figure 1

Dose-dependent effects of JAK inhibitor on its safety (PNG 278 kb)

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Supplemental figure 2

Diagram of publication bias analysis by funnel plot (PNG 88 kb)

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Wang, L., Ping, X., Chen, W. et al. Performance of Janus kinase inhibitors in psoriatic arthritis with axial involvement in indirect comparison with ankylosing spondylitis: a retrospective analysis from pooled data. Clin Rheumatol 40, 1725–1737 (2021). https://doi.org/10.1007/s10067-020-05442-4

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