The infection risks of JAK inhibition.
The infection risks of JAK inhibition.
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DOI：
10.1080/1744666x.2022.2014323
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发表时间：
2022-03
影响因子：
4.4
通讯作者：
Bechman K
中科院分区：
文献类型：
--
作者：
Adas MA;Alveyn E;Cook E;Dey M;Galloway JB;Bechman K
Janus激酶抑制剂（JAKi）已被证明在治疗免疫介导的炎症性疾病方面非常有效。与所有免疫调节治疗一样，仔细评估任何治疗相关的感染风险对于临床决策至关重要。我们使用已发表的II/III期试验结果、许可后和登记数据总结了目前关于许可JAKI感染率的文献。与安慰剂相比，许可的JAKI显示出增加的感染风险，最常见的是影响呼吸道和泌尿道，鼻咽和皮肤。该风险具有剂量依赖性。获得许可的JAKI剂量的风险与生物疗法相似。感染的其他风险因素，如年龄和类固醇联合处方，加剧了这种风险。与其他靶向免疫调节相比，JAKI更常见带状疱疹再激活，因此在适当的队列中筛查水痘暴露和接种疫苗是一种可取的策略。至关重要的是，这些小的风险增加必须与不受控制的自身免疫性疾病的已知危害（包括感染）相平衡。JAKI是一种安全的，潜在的变革性治疗方法，用于适当选择的患者。
Janus Kinase inhibitors (JAKi) have shown to be highly effective in the treatment of immune-mediated inflammatory diseases. As with all immunomodulatory therapies, careful assessment of any treatment-associated infection risk is essential to inform clinical decision-making. We summarize current literature on infection rates among the licensed JAKi using published phase II/III trial results, post-licensing and registry data. licensed JAKi show increased risk of infection across the class compared to placebo, most commonly affecting respiratory and urinary tracts, nasopharynx and skin. This risk is dose-dependent. Risks are similar at licensed JAKi doses to that seen with biologic therapies. The risk is compounded by other risk factors for infection, such as age and steroid co-prescription. Herpes zoster reactivation is more common with JAKi compared to other targeted immune modulation, making screening for varicella exposure and vaccination in appropriate cohorts an advisable strategy. Crucially, these small risk increases must be balanced against the known harms (including infection) of uncontrolled autoimmune disease. JAKi are a safe and potentially transformative treatment when used for appropriately selected patients.