Uveitis is an inflammatory disease affecting the uvea,which includes the iris,ciliary body and choroid(1).Noninfective uveitis is more prevalent in developed countries and primarily impacts individuals of working age,...Uveitis is an inflammatory disease affecting the uvea,which includes the iris,ciliary body and choroid(1).Noninfective uveitis is more prevalent in developed countries and primarily impacts individuals of working age,with a mean onset of around 40 years.It accounts for 5-10%of severe vision impairment globally(1,2).This form of uveitis is often associated with systemic diseases,such as ankylosing spondylosis,juvenile idiopathic arthritis,sarcoidosis and Behcet’s disease(2,3).展开更多
目的:系统评价两种选择性Janus激酶1(JAK-1)抑制药Upadacitinib和Filgotinib治疗类风湿性关节炎的疗效和安全性,为临床治疗提供循证参考。方法:计算机检索PubMed、Medline、Embase、Cochrane图书馆、中国生物医学文献数据库、中国期刊...目的:系统评价两种选择性Janus激酶1(JAK-1)抑制药Upadacitinib和Filgotinib治疗类风湿性关节炎的疗效和安全性,为临床治疗提供循证参考。方法:计算机检索PubMed、Medline、Embase、Cochrane图书馆、中国生物医学文献数据库、中国期刊全文数据库、万方数据和中文科技期刊数据库,检索时限均为自建库起至2019年1月,收集在甲氨蝶呤或其他抗风湿类药物的基础上,安慰剂(对照组)对比Upadacitinib或Filgotinib(试验组)治疗类风湿性关节炎的随机对照试验(RCT),进行资料提取并采用Cochrane系统评价员手册5.1.0进行质量评价后,采用Rev Man 5.3统计软件对疗效[按美国风湿病协会标准判断病情缓解20%的患者比例(ACR20)、ACR50、ACR70、28个关节疾病活动度评分(DAS28)<3.2的患者比例]和安全性[不良事件(AE)发生率、严重不良事件(SAE)发生率、感染发生率、严重感染发生率、带状疱疹发生率、肝损害发生率]进行Meta分析。结果:共纳入8项RCT,合计2 738例患者。Meta分析结果显示,试验组患者ACR20[OR=3.37,95%CI(2.80,4.05),P<0.001]、ACR50[OR=3.78,95%CI(2.98,4.78),P<0.001]、ACR70[OR=4.31,95%CI(3.05,6.09),P<0.001]、DAS28<3.2分的患者比例[OR=3.86,95%CI(2.98,5.00),P<0.001]、AE发生率[OR=1.33,95%CI(1.11,1.61),P=0.002]和感染发生率[OR=1.43,95%CI(1.12,1.81),P=0.004]均显著高于对照组,其余指标比较差异均无统计学意义(P>0.05)。结论:JAK-1抑制药Upadacitinib和Filgotinib在提高类风湿性关节炎患者的ACR20、ACR50、ACR70、DAS28<3.2的患者比例等疗效指标方面较好;不会增加SAE、严重感染、带状疱疹与肝损害的发生率,但会增加患者AE与感染的风险。展开更多
Recent advancements in the treatment landscape of ulcerative colitis(UC)have ushered in a new era of possibilities,particularly with the introduction of Janus kinase(JAK)-signal transducer and activator of transcripti...Recent advancements in the treatment landscape of ulcerative colitis(UC)have ushered in a new era of possibilities,particularly with the introduction of Janus kinase(JAK)-signal transducer and activator of transcription inhibitors.These novel agents offer a paradigm shift in UC management by targeting key signaling pathways involved in inflammatory processes.With approved JAK inhibitors(JAKis),such as tofacitinib,filgotinib,and upadacitinib,clinicians now have powerful tools to modulate immune responses and gene expression,potentially revolutionizing the treatment algorithm for UC.Clinical trials have demonstrated the efficacy of JAKis in inducing and maintaining remission,presenting viable options for patients who have failed conventional therapies.Real-world data support the use of JAKis not only as first-line treatments but also in subsequent lines of therapy,particularly in patients with aggressive disease phenotypes or refractory to biologic agents.The rapid onset of action and potency of JAKis have broadened the possibilities in the management strategies of UC,offering timely relief for patients with active disease and facilitating personalized treatment approaches.Despite safety concerns,including cardiovascular risks and infections,ongoing research and post-marketing surveillance will continue to refine our understanding of the risk-benefit profile of JAKis in UC management.展开更多
文摘Uveitis is an inflammatory disease affecting the uvea,which includes the iris,ciliary body and choroid(1).Noninfective uveitis is more prevalent in developed countries and primarily impacts individuals of working age,with a mean onset of around 40 years.It accounts for 5-10%of severe vision impairment globally(1,2).This form of uveitis is often associated with systemic diseases,such as ankylosing spondylosis,juvenile idiopathic arthritis,sarcoidosis and Behcet’s disease(2,3).
文摘目的:系统评价两种选择性Janus激酶1(JAK-1)抑制药Upadacitinib和Filgotinib治疗类风湿性关节炎的疗效和安全性,为临床治疗提供循证参考。方法:计算机检索PubMed、Medline、Embase、Cochrane图书馆、中国生物医学文献数据库、中国期刊全文数据库、万方数据和中文科技期刊数据库,检索时限均为自建库起至2019年1月,收集在甲氨蝶呤或其他抗风湿类药物的基础上,安慰剂(对照组)对比Upadacitinib或Filgotinib(试验组)治疗类风湿性关节炎的随机对照试验(RCT),进行资料提取并采用Cochrane系统评价员手册5.1.0进行质量评价后,采用Rev Man 5.3统计软件对疗效[按美国风湿病协会标准判断病情缓解20%的患者比例(ACR20)、ACR50、ACR70、28个关节疾病活动度评分(DAS28)<3.2的患者比例]和安全性[不良事件(AE)发生率、严重不良事件(SAE)发生率、感染发生率、严重感染发生率、带状疱疹发生率、肝损害发生率]进行Meta分析。结果:共纳入8项RCT,合计2 738例患者。Meta分析结果显示,试验组患者ACR20[OR=3.37,95%CI(2.80,4.05),P<0.001]、ACR50[OR=3.78,95%CI(2.98,4.78),P<0.001]、ACR70[OR=4.31,95%CI(3.05,6.09),P<0.001]、DAS28<3.2分的患者比例[OR=3.86,95%CI(2.98,5.00),P<0.001]、AE发生率[OR=1.33,95%CI(1.11,1.61),P=0.002]和感染发生率[OR=1.43,95%CI(1.12,1.81),P=0.004]均显著高于对照组,其余指标比较差异均无统计学意义(P>0.05)。结论:JAK-1抑制药Upadacitinib和Filgotinib在提高类风湿性关节炎患者的ACR20、ACR50、ACR70、DAS28<3.2的患者比例等疗效指标方面较好;不会增加SAE、严重感染、带状疱疹与肝损害的发生率,但会增加患者AE与感染的风险。
文摘Recent advancements in the treatment landscape of ulcerative colitis(UC)have ushered in a new era of possibilities,particularly with the introduction of Janus kinase(JAK)-signal transducer and activator of transcription inhibitors.These novel agents offer a paradigm shift in UC management by targeting key signaling pathways involved in inflammatory processes.With approved JAK inhibitors(JAKis),such as tofacitinib,filgotinib,and upadacitinib,clinicians now have powerful tools to modulate immune responses and gene expression,potentially revolutionizing the treatment algorithm for UC.Clinical trials have demonstrated the efficacy of JAKis in inducing and maintaining remission,presenting viable options for patients who have failed conventional therapies.Real-world data support the use of JAKis not only as first-line treatments but also in subsequent lines of therapy,particularly in patients with aggressive disease phenotypes or refractory to biologic agents.The rapid onset of action and potency of JAKis have broadened the possibilities in the management strategies of UC,offering timely relief for patients with active disease and facilitating personalized treatment approaches.Despite safety concerns,including cardiovascular risks and infections,ongoing research and post-marketing surveillance will continue to refine our understanding of the risk-benefit profile of JAKis in UC management.
