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.

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