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JAK-inhibitors for coronavirus disease-2019 (COVID-19): a meta-analysis

Chong-Xiang Chen1,2,3, Jiao-Jiao Wang4, Huan Li1,3

  • 1Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.

Leukemia
|May 15, 2021
PubMed

Insights

Janus kinase (JAK) inhibitors, including ruxolitinib and baricitinib, reduced mortality and invasive mechanical ventilation in COVID-19 patients. However, their impact on intensive care unit admissions and acute respiratory distress syndrome was borderline, with no effect on hospitalization length.

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Coronavirus infectious disease-2019 (COVID-19) poses significant risks, including high mortality and respiratory complications.
  • Janus kinase (JAK) inhibitors have emerged as potential therapeutic agents for managing severe COVID-19.
  • Understanding the safety and efficacy of JAK-inhibitors in COVID-19 patients is crucial for clinical decision-making.

Purpose of the Study:

  • To systematically evaluate the safety and efficacy of JAK-inhibitors in patients with COVID-19.
  • To assess the impact of JAK-inhibitors on key clinical outcomes, including mortality, mechanical ventilation, ICU admission, ARDS, and hospitalization duration.
  • To analyze data from published cohort studies and clinical trials on JAK-inhibitor use in COVID-19.

Main Methods:

  • A systematic review and meta-analysis of published literature on JAK-inhibitor use in COVID-19 patients.
  • Inclusion of studies published between January 1st and March 6th, 2021.
  • Quality assessment using Newcastle-Ottawa and Jadad scales; disease severity used as a proxy for treatment timing.
  • Analysis of data from 6 cohort studies and 5 clinical trials involving 2367 patients treated with ruxolitinib or baricitinib.

Main Results:

  • JAK-inhibitors significantly decreased the need for invasive mechanical ventilation (RR = 0.63; P = 0.002) and reduced overall mortality (RR = 0.42; P < 0.001).
  • Ruxolitinib and baricitinib showed significant reductions in mortality (RR = 0.33 and RR = 0.44, respectively).
  • Borderline impact was observed on intensive care unit admission (RR = 0.24; P = 0.05) and acute respiratory distress syndrome (RR = 0.50; P = 0.16).
  • No significant decrease in the length of hospitalization was found (MD = -0.18; P = 0.94).

Conclusions:

  • JAK-inhibitors demonstrate a significant survival benefit and reduce the need for mechanical ventilation in COVID-19 patients.
  • The timing of JAK-inhibitor administration during COVID-19 treatment may influence outcomes, but this requires further consistent reporting in studies.
  • Ruxolitinib and baricitinib show promise in managing severe COVID-19, warranting continued investigation into optimal treatment protocols.

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