The advent of Janus kinase (JAK) inhibitors, including tofacitinib, filgotinib, and upadacitinib, has significantly widened the therapeutic options for patients with inflammatory bowel disease (IBD). These agents offer the advantage of oral administration and have demonstrated efficacy in inducing and maintaining remission. However, concerns regarding their safety have emerged, particularly concerning cardiovascular and infectious complications, which appear more pronounced in patients with pre-existing risk factors such as older age, smoking, or comorbidities. While these risks are better understood, the potential association between JAK inhibitors and malignancies remains a subject of ongoing investigation. Current data from randomised controlled trials, pooled and integrated analyses, and real-world studies provide conflicting evidence regarding cancer risk. Notably, studies in patients with rheumatologic diseases treated with JAK inhibitors have contributed additional insights into long-term safety outcomes. Despite the uncertainty surrounding malignancy risks, it is likely that predisposing factors, including older age, smoking history, and long-standing IBD with chronic inflammation, play a more substantial role in cancer development than JAK inhibitor therapy alone. This paper reviews safety data from clinical trials, meta-analyses, and observational studies, focusing on cancer risk in patients treated with JAK inhibitors for IBD. We also review evidence from rheumatology studies, highlighting the need for individualised risk assessment and close monitoring to optimise the safety profile of these medications in clinical practice.
Janus激酶（JAK）抑制剂（如托法替尼、菲戈替尼和乌帕替尼）的出现，显著拓宽了炎症性肠病（IBD）患者的治疗选择。这类药物具有口服给药的便利性，并已在诱导和维持疾病缓解方面显示出疗效。然而，其安全性问题逐渐引起关注，尤其是心血管事件和感染性并发症，这些风险在已有高龄、吸烟或合并症等危险因素的患者中更为突出。尽管对这些风险已有更深入的认识，但JAK抑制剂与恶性肿瘤之间的潜在关联仍是当前研究的热点。来自随机对照试验、汇总与整合分析以及真实世界研究的数据，在癌症风险方面仍存在矛盾。值得注意的是，针对风湿性疾病患者使用JAK抑制剂的研究为长期安全性结果提供了更多见解。尽管恶性肿瘤风险尚不明确，但高龄、吸烟史以及长期慢性炎症性肠病等易感因素，可能在癌症发生中比JAK抑制剂治疗本身起到更重要的作用。本文综述了临床试验、荟萃分析和观察性研究中的安全性数据，重点关注JAK抑制剂治疗IBD患者的癌症风险。同时，我们回顾了风湿病学相关研究证据，强调在临床实践中需进行个体化风险评估和密切监测，以优化此类药物的安全性。
肿瘤(癌症)患者之家