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Janus kinases inhibitors for coronavirus disease-2019: A pairwise and Bayesian network meta-analysis
Jianyi Niu1,2, Zhiwei Lin1,2, Zhenfeng He1,2
1State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Background:
JAK (Janus kinases) inhibitors have been proposed as a promising treatment option for the coronavirus disease-2019 (COVID-19). However, the benefits of JAK inhibitors and the optimum thereof for COVID-19 have not been adequately defined.
Methods:
Databases were searched from their inception dates to 17 June 2022. Eligible studies included randomized controlled trials and observational studies. Extracted data were analyzed by pairwise and network meta-analysis. The primary outcome was the coefficient of mortality.
Results:
Twenty-eight studies of 8,206 patients were included and assessed qualitatively (modified Jadad and Newcastle-Ottawa Scale scores). A pairwise meta-analysis revealed that JAK inhibitors effectively reduced the mortality (OR = 0.54; 95% CI: 0.46-0.63; P < 0.00001; I 2 = 32%) without increasing the risk of adverse events (OR = 1.02; 95% CI: 0.88-1.18; P = 0.79; I 2 = 12%). In a network meta-analysis, clinical efficacy benefits were seen among different types of JAK inhibitors (baricitinib, ruxolitinib, and tofacitinib) without the observation of a declined incidence of adverse events. The assessment of rank probabilities indicated that ruxolitinib presented the greatest likelihood of benefits regarding mortality and adverse events.
Conclusion:
JAK inhibitors appear to be a promising treatment for COVID-19 concerning reducing mortality, and they do not increase the risk of adverse events vs. standard of care. A network meta-analysis suggests that mortality benefits are associated with specific JAK inhibitors, and among these, ruxolitinib presents the greatest likelihood of having benefits for mortality and adverse events.
Systematic Review Registration:
[www.crd.york.ac.uk/prospero], identifier [CRD42022343338].
Insights
Janus kinase (JAK) inhibitors effectively reduce mortality in COVID-19 patients without increasing adverse events. Ruxolitinib shows the greatest potential benefit for both mortality and safety outcomes among JAK inhibitors.
Area of Science:
- Immunology
- Pharmacology
- Infectious Diseases
Background:
- Janus kinase (JAK) inhibitors are being investigated as a potential treatment for coronavirus disease-2019 (COVID-19).
- The precise benefits and optimal use of JAK inhibitors for COVID-19 remain unclear.
Conclusions:
- Janus kinase (JAK) inhibitors represent a promising therapeutic option for reducing mortality in COVID-19 patients compared to standard care.
- The safety profile of JAK inhibitors is favorable, with no increased risk of adverse events.
- Ruxolitinib emerges as a potentially superior JAK inhibitor, offering the greatest likelihood of benefits in terms of both mortality reduction and adverse event management in COVID-19.
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