3种Janus激酶抑制剂治疗类风湿关节炎的快速卫生技术评估  

Three Janus kinase inhibitors in the treatment of rheumatoid arthritis:a rapid health technology assessment

作　　者：李宇 冯晓俊 吕鹏 张京莉[1] 史天陆 LI Yu;FENG Xiaojun;Lyu Peng;ZHANG Jingli;SHI Tianlu(Department of Pharmacy,Taihe County People’s Hospital of Anhui Province/Taihe Hospital Affiliated to Wannan Medical College,Fuyang 236600,Anhui Province,China;Department of Pharmacy,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China)

机构地区：[1]安徽省太和县人民医院/皖南医学院附属太和医院药剂科,安徽阜阳236600 [2]中国科学技术大学附属第一医院(安徽省立医院)药学部,合肥230001

出　　处：《药物流行病学杂志》2025年第4期437-447,共11页Chinese Journal of Pharmacoepidemiology

基　　金：国家自然科学基金青年科学基金项目(82003740)。

摘　　要：目的采用快速卫生技术评估方法评价3种Janus激酶抑制剂治疗类风湿关节炎(RA)的有效性、安全性和经济性,为药品准入和临床合理用药提供依据。方法计算机检索PubMed、Cochrane Library、Embase、CNKI、WanFang Data数据库和国外卫生技术评估(HTA)机构官方网站,搜集托法替布、巴瑞替尼、乌帕替尼治疗RA的HTA报告、系统评价/Meta分析和药物经济学研究,检索时限均从建库至2024年12月31日。由2名研究者独立筛选文献、提取资料并评价纳入文献的质量后,对结果进行描述性分析。结果共纳入16篇文献,包括系统评价/Meta分析12篇,药物经济学研究4篇。有效性方面,以美国风湿病学会(ACR)评估标准症状缓解20%(ACR20)、缓解50%(ACR50)、缓解70%(ACR70)应答率和类风湿关节炎疾病活动评分28(DAS28)<2.6达标率为有效性指标,乌帕替尼30 mg和乌帕替尼15 mg治疗RA患者具有较好的有效性。安全性方面,乌帕替尼15 mg的不良事件发生率最低;托法替布5 mg的严重不良事件发生率最低。经济性方面,相较于托法替布、巴瑞替尼,乌帕替尼15 mg最具经济性。结论乌帕替尼15 mg治疗RA患者具有较好的有效性、安全性和经济性。Objective To evaluate the efficacy,safety and economy of three Janus kinase inhibitors in the treatment of rheumatoid arthritis(RA)using a rapid health technology assessment method,and to provide a basis for drug access and rational clinical use.Methods PubMed,Cochrane Library,Embase,CNKI,WanFang Data databases and the official websites of foreign health technology assessment(HTA)institutions were searched electronically to collect HTA reports,systematic reviews/Meta-analysis and pharmacoeconomics studies of tofacitinib,baricitinib,and upadacitinib in the treatment of RA from inception to December 31,2024.Two reviewers independently screened the literature,extracted information and performed quality assessment of the included studies,and then performed descriptive analysis on the results.Results A total of 16 literature were included,including 12 systematic reviews/Meta-analysis and 4 pharmacoeconomic studies.In terms of efficacy,taking the American College of Rheumatology(ACR)evaluation criteria for symptom relief 20%(ACR20),ACR50,ACR70 and disease activity score 28(DAS28)<2.6 response rates as the efficacy indicators,upadacitinib 30 mg and upadacitinib 15 mg had better effectiveness in the treatment of RA patients.In terms of safety,the incidence of adverse drug events was the lowest in RA patients treated with 15 mg of upadacitinib.The incidence of serious adverse drug events in RA patients treated with tofacitinib 5 mg was the lowest.In terms of economy,compared with tofacitinib and baricitinib,upadacitinib 15 mg was the most economical.Conclusion Upadacitinib 15 mg has better efficacy,safety and economy in the treatment of RA patients.

关 键 词：托法替布 巴瑞替尼 乌帕替尼 类风湿关节炎 快速卫生技术评估 

分 类 号：R593.22[医药卫生—内科学]