Clinical Efficacy, Safety of Janus Kinase Inhibitors in Patients Hospitalized With COVID-19

In patients hospitalized with COVID-19, treatment with janus kinase (JAK) inhibitors was found to be clinically safe and was associated with improved outcomes, according to results of a systematic review and meta-analysis published in International Immunopharmacology.

Investigators conducted a meta-analysis of 3 randomized controlled trials (RCT) that compared the clinical efficacy and safety of JAK inhibitors with placebo or standard care for the treatment of patients with COVID-19. They included only studies that reported clinical efficacy and adverse event risk in the final analysis. The primary outcome was all-cause mortality at day 28. In addition, the investigators used I² measurement to assess statistical heterogeneity (P <.10 or I² >50%).

A total of 1363 adult patients from the 3 RCTs were included in the intention-to-treat population. Of 680 patients who were treated with a JAK inhibitor, 21 received ruxolitinib, 515 received baricitinib, and 44 received tofacitinib.

At day 28, the all-cause mortality rate was 4.1% among patients who received JAK inhibitors and 7% among those who received placebo or standard care (odds ratio [OR], 0.57; 95% CI, 0.36-0.92; I² =0).

Of the patients included in the study, a clinical recovery rate of 85.1% was noted among those treated with JAK inhibitors compared with 80% among those in control group (OR, 1.45; 95% CI, 1.09-1.93; I² =0). Treatment with JAK inhibitors was associated with a shorter time to recovery (mean difference [MD], –2.84; 95% CI, –5.56 to –0.12; I² =50%), a decreased rate of invasive mechanical ventilation (MD, –1.46; 95% CI, –2.74 to –0.18; I² =64%), and a shorter hospital stay (MD, –1.20; 95% CI, –2.01 to –0.39; I² =0%)compared with placebo or standard care. In addition, treatment with JAK inhibitors did not significantly increase the risk for moderate or severe adverse events compared with placebo or standard care.

The study was limited by its inclusion of only 3 RCTs in the final analysis, the variation in standard care for COVID-19 among the 3 RCTs, and the use of only 3 JAK inhibitors.

These findings support “the repurposing of JAK inhibitors to improve the treatment strategies for COVID-19,” the investigators concluded.

Reference

Chen CY, Chen WC, Hsu CK, Chao CM, Lai CC. Clinical efficacy and safety of Janus kinase inhibitors for COVID-19: A systematic review and meta-analysis of randomized controlled trials. Int Immunopharmacol. Published online July 31, 2021. doi:10.1016/j.intimp.2021.108027