Although found to increase the risk of infectious complications, janus kinase (JAK) inhibitors effectively induce clinical remission in patients with Crohn disease (CD) and clinical and endoscopic remission in patients with ulcerative colitis (UC), according to results of a recently published systematic review and meta-analysis.
The study authors systematically searched PubMed, Embase, and CENTRAL for randomized controlled trials (RCTs) comparing the safety and efficacy of JAK inhibitors to placebo in adult CD and UC patients. A random-effects model was utilized to pool rates of clinical, endoscopic, and safety outcomes relative to placebo.
The analysis included 12 RCTs: 5 evaluating patients with CD and 7 evaluating patients with UC. A total of 813 CD patients and 2637 UC patients were randomized to 6 groups: placebo (n=844), tofacitinib (n=1882), filgotinib (n=130), peficitinib (n=176), upadacitinib (n=387), and TD‐1473 (n=31).
“JAK inhibitor treatment was associated with induction of clinical remission in CD (RR, relative risk 1.38 [95% confidence interval CI 1.04‐1.83], P =.025, I2 = 14%) and UC (RR 3.07 [95% CI 2.03‐4.63], P <.001, I2 = 0%),” the study authors reported. Additionally, in UC patients, findings revealed an association between JAK inhibitor therapy and induction of endoscopic remission (endoscopic Mayo subscore [MCSe]: 0/1) (RR: 2.43; 95% CI: 1.64, 3.59; P <.001; I2: 27%) as well as mucosal healing (MCSe: 0) (RR: 5.50; 95% CI: 2.46, 12.32; P <.001, I2: 0%).
The study authors also reported that the analysis of safety outcomes was found to be “generally reassuring.” Findings revealed that the overall risk of adverse events (AEs) was not significantly higher in CD and UC patients treated with a JAK inhibitor (RR: 1.02; 95%: 0.97, 1.09; P =.412; χ2 =5.29; I2: 0%). It was noted, however, that patients treated with a JAK inhibitor were found to have an increased risk of infection compared with placebo patients (RR: 1.40; 95% CI: 1.18, 1.67; P <.001; I2: 0%). This was particularly the case for herpes zoster infection.
“Additional studies are required to understand the optimal positioning of these agents in management algorithms for CD and UC, and to refine methods of drug delivery, maximise treatment efficacy and minimize potential harms associated with JAK inhibition,” the authors concluded.
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