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Impact of Janus kinase inhibitors on risk of cardiovascular events in patients with rheumatoid arthritis: systematic review and meta-analysis of randomised controlled trials

Annals of the rheumatic diseases, 2019-08, Vol.78 (8), p.1048-1054 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. ;2019 Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. ;ISSN: 0003-4967 ;EISSN: 1468-2060 ;DOI: 10.1136/annrheumdis-2018-214846 ;PMID: 31088790

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Title:
Impact of Janus kinase inhibitors on risk of cardiovascular events in patients with rheumatoid arthritis: systematic review and meta-analysis of randomised controlled trials
Author: Xie, Wenhui ; Huang, Yanrong ; Xiao, Shiyu ; Sun, Xiaoying ; Fan, Yong ; Zhang, Zhuoli
Subjects: Adult ; Arthritis, Rheumatoid - diagnosis ; Arthritis, Rheumatoid - drug therapy ; Blood clots ; Cardiovascular diseases ; Cardiovascular Diseases - chemically induced ; Cardiovascular Diseases - epidemiology ; Clinical trials ; Cytokines ; Dosage ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug dosages ; Drug Therapy, Combination ; FDA approval ; Female ; Health risk assessment ; Humans ; Janus kinase ; Janus Kinase Inhibitors - adverse effects ; Janus Kinase Inhibitors - therapeutic use ; Male ; Middle Aged ; Pharmaceutical industry ; Prevalence ; Prognosis ; Randomized Controlled Trials as Topic ; Rheumatoid arthritis ; Rheumatology ; Risk Assessment ; Severity of Illness Index ; Studies ; Systematic review ; Thromboembolism ; Tumor necrosis factor-TNF
Is Part Of: Annals of the rheumatic diseases, 2019-08, Vol.78 (8), p.1048-1054
Description: ObjectivesTo investigate the effect of Janus kinase inhibitors (Jakinibs) on cardiovascular risk in adult patients with rheumatoid arthritis (RA) via a meta-analysis of randomised controlled trials (RCTs).MethodsPubMed, Embase and Cochrane library were thoroughly searched for RCTs reporting safety issues in patients with RA receiving Jakinibs, from inception to October 2018. The primary and secondary outcomes were all cardiovascular events (CVEs) and major adverse cardiovascular events (MACEs)/venous thromboembolism events (VTEs). OR and 95% CI were calculated using the Mantel-Haenszel fixed-effect method.Results26 RCTs randomising 11 799 patients were included. No significant difference was observed regarding all CVEs risk following Jakinibs usage in general (OR 1.04 (0.61 to 1.76), p = 0.89), tofacitinib (OR 0.63 (0.26 to 1.54), p = 0.31), baricitinib (OR 1.21 (0.51 to 2.83), p = 0.66), upadacitinib (OR 3.29 (0.59 to 18.44), p = 0.18), peficitinib (OR 0.43 (0.07 to 2.54), p = 0.35) or decernotinib (OR 1.12 (0.13 to 10.11), p = 0.92). Likewise, there was no significant difference for Jakinibs treatment overall regarding occurrence of MACEs (OR 0.80 (0.36 to 1.75), p = 0.57) or VTEs (OR 1.16 (0.48 to 2.81), p = 0.74). Dose-dependent impact of Jakinibs on the risks of all CVEs, MACEs and VTEs was not observed in tofacitinib (5 mg vs 10 mg), upadacitinib (15 mg vs 30 mg), whereas baricitinib at 2 mg was found to be safer than 4 mg in all CVEs incidence (OR 0.19 (0.04 to 0.88), p = 0.03).ConclusionThe existing evidence from RCTs indicated no significant change in cardiovascular risk for Jakinib-treated patients with RA in a short-term perspective, but postmarketing data are sorely needed to ascertain their cardiovascular safety, especially at the higher dose, due to increased risk of thromboembolism events for both tofacitinib and baricitinib at higher dosage.
Publisher: England: BMJ Publishing Group LTD
Language: English
Identifier: ISSN: 0003-4967
EISSN: 1468-2060
DOI: 10.1136/annrheumdis-2018-214846
PMID: 31088790
Source: MEDLINE
ProQuest Central

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Impact of Janus kinase inhibitors on risk of cardiovascular events in patients with rheumatoid arthritis: systematic review and meta-analysis of randomised controlled trials

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