BTK inhibitors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): A systematic review
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Michael Stack1, Keith Sacco1, Riccardo Castagnoli1
1Laboratory of Clinical Immunology and Microbiology, Immunodeficiency Genetics Section, NIAID, NIH, Bethesda, MD, USA.
Introduction:
The Bruton tyrosine kinase (BTK) regulates B cell and macrophage signaling, development, survival, and activation. Inhibiting BTK has been hypothesized to ameliorate lung injury in patients with severe COVID-19, however clinical outcome data is inconclusive.
Objective:
To evaluate the clinical outcomes of BTK inhibitors (BTKinibs) in patients with COVID-19.
Evidence Review:
We searched PubMed, Embase, and Web of Science:Core on December 30, 2020. Clinical studies with at least 5 COVID-19 patients treated with BTKinibs were included. Case reports and reviews were excluded.
Findings:
125 articles were identified, 6 of which met inclusion criteria. The most common clinical outcomes measured were oxygen requirements (4/6) and hospitalization rate or duration (3/6). Three studies showed decreased oxygen requirements in patients who started or continued BTKinibs. All three studies that evaluated hospitalization rate or duration found favorable outcomes in those on BTKinibs.
Conclusions And Relevance:
BTKinib use was associated with decreased oxygen requirements and decreased hospitalization rates and duration.
Insights
Bruton tyrosine kinase (BTK) inhibitors may reduce oxygen needs and hospitalization for severe COVID-19 patients. Further research is needed to confirm these promising findings for BTK inhibition in critical care.
Area of Science:
- Immunology
- Pharmacology
- Critical Care Medicine
Background:
- Bruton tyrosine kinase (BTK) plays a key role in B cell and macrophage signaling.
- BTK inhibition is hypothesized to mitigate lung injury in severe COVID-19.
- Existing clinical data on BTK inhibitors for COVID-19 is inconclusive.
Purpose of the Study:
- To evaluate the clinical outcomes of Bruton tyrosine kinase inhibitors (BTKinibs) in patients with COVID-19.
- To synthesize evidence on the efficacy of BTK inhibitors in managing severe COVID-19 symptoms.
Main Methods:
- Systematic search of PubMed, Embase, and Web of Science:Core databases up to December 30, 2020.
- Inclusion of clinical studies with at least 5 COVID-19 patients treated with BTKinibs.
- Exclusion of case reports and reviews to focus on robust clinical data.
Main Results:
- Six studies met the inclusion criteria from 125 identified articles.
- Common outcomes assessed included oxygen requirements and hospitalization rates/duration.
- Three studies indicated reduced oxygen needs, and all three evaluating hospitalization found favorable outcomes with BTKinibs.
Conclusions:
- BTK inhibitor use in COVID-19 patients was associated with decreased oxygen requirements.
- BTK inhibition demonstrated potential for reducing hospitalization rates and duration.
- These findings suggest a potential therapeutic role for BTK inhibitors in severe COVID-19.
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