Janus kinase inhibitors and the risk of infections: a network meta-analysis across disease indications

作者：Xiaoqi Li, Qiaozhi Hu, Ting Xu · 发表于：Expert Opinion on Drug Safety · 年份：2025 · DOI：10.1080/14740338.2025.2502037 · 被引用次数：6 · 研究领域：Rheumatoid Arthritis Research and Therapies、Spondyloarthritis Studies and Treatments、Cytokine Signaling Pathways and Interactions

INTRODUCTION: To compare the risks of serious infections, herpes zoster (HZ), and opportunistic infections associated with Janus kinase (JAK) inhibitors versus placebo, tumor necrosis factor-α inhibitors (TNFi), methotrexate (MTX), and among different JAK inhibitors. METHODS: We searched PubMed, Embase, Cochrane Library, and Web of Science databases from their inception until 23 January 2024. Network meta-analysis estimated odds ratios for infections using restricted maximum likelihood models. RESULTS: Eighty randomized controlled trials were included with 40,460 patients. Part of JAK inhibitors including tofacitinib (5 mg [2.01; 95%CI, 1.25-3.23], 10 mg [1.84; 95%CI, 1.06-3.17]), baricitinib (4 mg [1.57; 95%CI, 1.05-2.35]), and upadacitinib (15 mg [1.55; 95%CI, 1.06-2.27], 30 mg [1.94; 95%CI, 1.26-2.98]), exhibited a significantly different risk of serious infections compared to placebo. Similarly, tofacitinib (10 mg), baricitinib (4 mg), upadacitinib (15 mg, 30 mg), abrocitinib (200 mg), and peficitinib (100 mg) showed a significantly different risk of HZ infection compared to placebo. Most JAK inhibitors didn't raise opportunistic infections risks vs. TNFi and MTX, and risks among JAK inhibitors weren't statistically significant. CONCLUSION: Attention should be paid to JAK inhibitor's types, dosages, and it is important to be aware of the risk of serious infections and HZ infections. Future long-term studies should be conducted. PROSPERO: CRD42024523067.