外用 Janus 激酶和磷酸二酯酶抑制剂-4 抑制剂治疗特应性皮炎的有效性和安全性：网络荟萃分析,The Journal of Dermatology

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外用 Janus 激酶和磷酸二酯酶抑制剂-4 抑制剂治疗特应性皮炎的有效性和安全性：网络荟萃分析
The Journal of Dermatology ( IF 2.9 ) Pub Date : 2021-09-06 , DOI: 10.1111/1346-8138.16126
Lu Zhang _{1,

2} , Dan Du _{1,

2} , Lian Wang _{1,

2} , Linghong Guo _{1,

2} , Xian Jiang _{1,

2}

Affiliation

外用 Janus 激酶 (JAK) 和磷酸二酯酶-4 (PDE4) 抑制剂是特应性皮炎 (AD) 的新型治疗方法。本研究旨在比较 JAK 和 PDE4 抑制剂治疗 AD 的疗效和安全性。检索了 PubMed、EMBASE、Web of Science 和 Cochrane Library 的数据库，直到 2021 年 6 月，以寻找接受局部 JAK 和 PDE4 抑制剂治疗的 AD 患者的合格研究。提取基线和随访数据。使用研究者的全球评估 (IGA) 评估 JAK 抑制剂的功效，达到“清除”或“几乎清除”，在治疗结束时比基线改善 2 分或更多，称为“IGA 反应”）。进行了具有固定效应的贝叶斯多重治疗网络荟萃分析。优势比 (OR) 和 95% 可信区间 (CrI) 用于比较 JAK 和 PDE4 抑制剂与安慰剂对 AD 的疗效。共纳入 10 项外用 JAK 和 PDE4 抑制剂的随机对照试验，涉及 4689 名患者进行分析。总共包括三种局部 JAK 抑制剂和两种局部 PDE4 抑制剂。与安慰剂相比，所有 JAK 和 PDE4 抑制剂在治疗 4 周时具有更高的 IGA 反应。值得注意的是，与外用他克莫司和皮质类固醇相比，托法替尼 2% 出价、鲁索替尼 1.5% 出价和德尔戈西替尼 3% 出价的安全性相似，显示出良好的 IGA 反应。排名分析表明，在所有包括的 JAK 和 PDE4 抑制剂中，托法替尼 2%bid 达到 IGA 反应的可能性最高（SUCRA = 0.880）。除了，JAK 和 PDE4 抑制剂显示出与安慰剂的非劣安全性。该研究证实，外用 JAK 和 PDE4 抑制剂对 AD 患者具有良好的治疗效果和安全性。托法替尼 2% 出价、鲁索替尼 1.5% 出价和德尔戈替尼 3% 出价显示优于其他 JAK 和 PDE4 抑制剂的疗效。

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Efficacy and safety of topical Janus kinase and phosphodiesterase inhibitor-4 inhibitors for the treatment of atopic dermatitis: A network meta-analysis

Topical Janus kinase (JAK) and phosphodiesterase-4 (PDE4) inhibitors are novel treatment approaches for atopic dermatitis (AD). This study aimed to compare the efficacy and safety of JAK and PDE4 inhibitors for AD treatment. The databases of PubMed, EMBASE, Web of Science, and Cochrane Library were searched until June 2021 for eligible studies of AD patients treated with topical JAK and PDE4 inhibitors. Baseline and follow-up data were extracted. Efficacy of JAK inhibitors was evaluated using Investigator’s Global Assessment (IGA) achieving “clear” or “almost clear”, with 2 points or more improvement from baseline at the end of treatment, referred to as “IGA response”). A Bayesian multiple treatment network meta-analysis with fixed effects was performed. Odds ratio (OR) with 95% credibility interval (CrI) were used for comparing the efficacy of JAK and PDE4 inhibitors with placebo for AD. A total of 10 randomized controlled trials of topical JAK and PDE4 inhibitors with 4689 patients were included for analysis. A total of three topical JAK inhibitors and two topical PDE4 inhibitors were included. Compared with placebo, all JAK and PDE4 inhibitors had higher IGA response at 4 weeks of treatment. Notably, with similar safety profile, tofacitinib 2% b.i.d., ruxolitinib 1.5% b.i.d., and delgocitinib 3% b.i.d. showed favorable IGA response compared with topical tacrolimus and corticosteroids. Ranking analysis suggested that among all included JAK and PDE4 inhibitors, tofacitinib 2% b.i.d. had the highest probability of achieving IGA response (SUCRA = 0.880). Besides, JAK and PDE4 inhibitors showed non-inferior safety profile with placebo. This study confirmed that topical JAK and PDE4 inhibitors had promising treatment efficacy and safety for AD patients. Tofacitinib 2% b.i.d., ruxolitinib 1.5% b.i.d. and delgocitinib 3% b.i.d. showed superior efficacy over other JAK and PDE4 inhibitors.

更新日期：2021-09-06

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