Summary

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• This summary is based on the review of 75 systematic review(s)/meta-analysis(es). ^[1-74]
• Ulcerative Colitis: Tofacitinib demonstrated higher clinical remission rates compared to vedolizumab and anti-tumor necrosis factor (TNF)-alpha agents, achieving comparable steroid-free clinical remission to ustekinumab. Vedolizumab showed higher clinical remission rates than anti-TNF-alpha agents, while upadacitinib ranked best for clinical remission and mucosal healing in re-randomized patients.
• Rheumatoid Arthritis: Tofacitinib exhibited significant improvement in American College of Rheumatology (ACR) 20/50/70 responses compared to placebo and adalimumab, ranking higher for efficacy among Janus kinase (JAK) inhibitors. Upadacitinib and baricitinib also demonstrated significant efficacy, with upadacitinib 15 mg + conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) showing good efficacy in combination therapy.
• Psoriatic Arthritis: Tofacitinib demonstrated efficacy in reducing psoriatic arthritis response criteria (PsARC) and ACR 50 responses, showing comparable effectiveness to other biological agents, including secukinumab, infliximab, and adalimumab, which ranked highest in efficacy.
• Ankylosing Spondylitis: JAK inhibitors, including filgotinib, upadacitinib, and tofacitinib, showed significant ASAS 20/40 responses, with tofacitinib ranking highest in achieving ASAS20.
• Tofacitinib presents similar adverse event rates across therapies, with an increased risk of herpes zoster infections compared to other biologics and csDMARDs. In the context of ulcerative colitis, there are concerns regarding infections, particularly C. difficile.
• Serious Adverse Events (SAEs) were comparable across most therapies, with some studies indicating a higher incidence of SAEs for upadacitinib 15 mg relative to other JAK inhibitors. No significant increased risk of malignancy was noted compared to csDMARDs or TNFi.
• In Psoriatic Arthritis, JAK inhibitors showed an increased risk of infections, especially upper respiratory infections, but there was no significant increase in serious adverse events compared to placebo.
• In Ankylosing Spondylitis, JAK inhibitors did not demonstrate significant differences in adverse events and serious adverse events compared to placebo.
• In patients with prior biologic exposure for ulcerative colitis, upadacitinib and ustekinumab demonstrated higher remission rates, while infliximab showed higher efficacy in biologic-naive patients. In rheumatoid arthritis, JAK inhibitors like tofacitinib, upadacitinib, and baricitinib exhibited significant efficacy in patients with inadequate response to csDMARDs and comparable efficacy in biologic-experienced patients.
• For psoriatic arthritis, tofacitinib and other biologics, including secukinumab and adalimumab, were effective in both biologic-naive and experienced patients, while in ankylosing spondylitis, tofacitinib and other JAK inhibitors showed high efficacy in TNF inhibitor-naive patients.