Liver function changes in rheumatoid arthritis patients treated with tofacitinib: systematic review / 中华风湿病学杂志

ABSTRACT

Objective To evaluate the effects of tofacitinib on liver function in rheumatoid arthritis (RA) patients.Methods Literature search was performed in databases including PubMed,Cochrane Library,China National Knowledge Infrastructure and Wanfang to identify randomized controlled trials about RA treated with tofacitinib.The retrieval time was up to August 2016.Meta-analysis was conducted by Revman 5.5 software.Results A total of 7 studies were included,involving 2 965 patients.The results of Meta-analysis revealed that the incidence of alanine transaminase (ALT)＞1 upper limit of normal (ULN) in patients receiving both 5 mg and 10 mg bid tofacitinib was significantly higher than placebo [5 mg bid tofacitinibRR=1.48,95％CI (1.20,1.82),P=0.000 2;10 mg bid tofacitinibRR=1.67,95％CI (1.37,2.05),P＜0.01];there was no significant difference in the incidence of ALT＞3 ULN [5 mg bid tofacitinibRR=1.81,95％CI (0.57,5.79),P=0.32;10 mg bid tofacitinibRR=1.36,95％CI (0.57,5.25),P=0.49];the incidence of aspartate transaminase (AST)＞1 ULN was significantly higher than placebo [5 mg bid tofacitinibRR=1.59,95％CI (1.25,2.03),P=0.000 2;10 mg bid tofacitinibRR=1.90,95％CI(1.50,2.40),P＜0.01],there was no significant difference in the incidence of AST＞3 ULN [5 mg bid tofacitinibRR=1.17,95％CI (0.27,5.17),P=0.83;10 mg bid tofacitinibRR=0.95,95％CI (0.26,3.44),P=0.94].Conclusion Tofacitinib slightly increases ALT and AST in patient with RA.Due to the limited sources and lack of domestic studies,more randomized controlled trials are still needed to verify the above conclusion.