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Janus 激酶抑制剂与主要 COVID-19 结局:是时候忘记两面神 Janus 了!随机对照试验的荟萃分析。

Janus kinase inhibitors and major COVID-19 outcomes: time to forget the two faces of Janus! A meta-analysis of randomized controlled trials.

机构信息

Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Konstantinoupoleos 49, 54642, Thessaloniki, Greece.

Veterans Affairs Medical Center, George Washington University, Washington, DC, USA.

出版信息

Clin Rheumatol. 2021 Nov;40(11):4671-4674. doi: 10.1007/s10067-021-05884-4. Epub 2021 Aug 24.


DOI:10.1007/s10067-021-05884-4
PMID:34431004
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8384394/
Abstract

Coronavirus disease-2019 (COVID-19) represents a global public health nightmare. The "cytokine storm," the most prominent underlying pathophysiologic mechanism of this disease, can theoretically be targeted at several stages. Janus kinase (JAK) inhibitors constitute a drug class that could ameliorate the inflammatory response and enhance antibody production. Herein, we aimed to evaluate the efficacy of JAK inhibitors in patients with COVID-19, performing the most updated relevant meta-analysis. We searched two major databases for randomized controlled trials (RCTs) enrolling adult patients with documented COVID-19 in the in-hospital setting, assigned either to JAK inhibitor treatment plus standard of care or standard of care alone. We set as primary efficacy outcome the endpoint of COVID-19 death on day 28 and as secondary efficacy composite outcome that of mechanical ventilation or initiation of extracorporeal membrane oxygenation (ECMO). We finally pooled data of interest from 4 RCTs in a total of 1338 subjects with documented COVID-19 infection, utilizing the following JAK inhibitors: baricitinib, ruxolitinib, tofacitinib, and nezulcitinib. Treatment with JAK inhibitor compared to control resulted in a significant reduction in the risk for COVID-19 death by 43%, while it also led to a significant decrease in the risk for mechanical ventilation or ECMO initiation by 36%. Herein, we demonstrate a clear benefit with JAK inhibitors added to standard of care in patients with COVID-19 in terms of risk reduction concerning major outcomes. Larger RCTs will elucidate their place in treatment armamentarium against COVID-19.

摘要

新型冠状病毒病 2019(COVID-19)代表了一场全球性的公共卫生噩梦。这种疾病最突出的潜在病理生理机制“细胞因子风暴”,理论上可以针对多个阶段进行靶向治疗。Janus 激酶(JAK)抑制剂是一类可以改善炎症反应和增强抗体产生的药物。在此,我们旨在评估 JAK 抑制剂在 COVID-19 患者中的疗效,进行了最新的相关荟萃分析。我们在两个主要数据库中搜索了随机对照试验(RCT),这些试验纳入了在院治疗的有记录的 COVID-19 成年患者,分为 JAK 抑制剂治疗加标准治疗或仅标准治疗。我们将 COVID-19 死亡的 28 天终点作为主要疗效终点,将机械通气或开始体外膜氧合(ECMO)的复合疗效终点作为次要疗效终点。我们最终汇总了 4 项 RCT 共 1338 例有记录的 COVID-19 感染患者的数据,使用以下 JAK 抑制剂:巴瑞替尼、芦可替尼、托法替尼和奈齐利替尼。与对照组相比,JAK 抑制剂治疗可使 COVID-19 死亡风险降低 43%,同时使机械通气或 ECMO 开始的风险降低 36%。在此,我们证明了 JAK 抑制剂联合标准治疗在 COVID-19 患者中的主要结局风险降低方面具有明显的益处。更大规模的 RCT 将阐明它们在对抗 COVID-19 的治疗武器库中的地位。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7c7c/8384394/662cab735661/10067_2021_5884_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7c7c/8384394/00898dbc5598/10067_2021_5884_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7c7c/8384394/662cab735661/10067_2021_5884_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7c7c/8384394/00898dbc5598/10067_2021_5884_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7c7c/8384394/662cab735661/10067_2021_5884_Fig2_HTML.jpg

相似文献

[1]
Janus kinase inhibitors and major COVID-19 outcomes: time to forget the two faces of Janus! A meta-analysis of randomized controlled trials.

Clin Rheumatol. 2021-11

[2]
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Int Immunopharmacol. 2021-10

[3]
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Curr Opin Crit Care. 2021-10-1

[4]
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Lancet. 2022-7-30

[5]
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[6]
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Expert Rev Anti Infect Ther. 2022-5

[7]
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[8]
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[9]
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[10]
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BMC Infect Dis. 2021-1-11

引用本文的文献

[1]
JAK Inhibitors in Cytokine Storm Syndromes.

Adv Exp Med Biol. 2024

[2]
Cytokine Storm in COVID-19: Insight into Pathological Mechanisms and Therapeutic Benefits of Chinese Herbal Medicines.

Medicines (Basel). 2024-7-18

[3]
An Update on SARS-CoV-2 Clinical Trial Results-What We Can Learn for the Next Pandemic.

Int J Mol Sci. 2023-12-26

[4]
Omicron related COVID-19 prevention and treatment measures for patients with hematological malignancy and strategies for modifying hematologic treatment regimes.

Front Cell Infect Microbiol. 2023

[5]
The development of COVID-19 treatment.

Front Immunol. 2023

[6]
The JAK-STAT Signaling Pathway in Epilepsy.

Curr Neuropharmacol. 2023

[7]
Role of SARS-CoV-2-induced cytokine storm in multi-organ failure: Molecular pathways and potential therapeutic options.

Int Immunopharmacol. 2022-12

[8]
Oral Janus kinase inhibitors for treating hospitalized patients with COVID-19: An updated systematic review and meta-analysis of randomized controlled trials.

J Microbiol Immunol Infect. 2022-12

[9]
Janus kinase inhibitors for the treatment of COVID-19.

Cochrane Database Syst Rev. 2022-6-13

[10]
JAK inhibitors and COVID-19.

J Immunother Cancer. 2022-4

本文引用的文献

[1]
A phase 2 multiple ascending dose study of the inhaled pan-JAK inhibitor nezulcitinib (TD-0903) in severe COVID-19.

Eur Respir J. 2021-10

[2]
Tofacitinib in Patients Hospitalized with Covid-19 Pneumonia.

N Engl J Med. 2021-7-29

[3]
The cytokine storms of COVID-19, H1N1 influenza, CRS and MAS compared. Can one sized treatment fit all?

Cytokine. 2021-8

[4]
JAK-inhibitors for coronavirus disease-2019 (COVID-19): a meta-analysis.

Leukemia. 2021-9

[5]
A Novel Report on the Compassionate Use of Baricitinib in Treating a Pediatric Patient With Severe Symptoms of COVID-19 Infection.

J Med Cases. 2021-3

[6]
The use of Janus Kinase inhibitors in hospitalized patients with COVID-19: Systematic review and meta-analysis.

Clin Epidemiol Glob Health. 2021

[7]
Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19.

N Engl J Med. 2021-3-4

[8]
Cytokine Storm.

N Engl J Med. 2020-12-3

[9]
Compassionate use of JAK1/2 inhibitor ruxolitinib for severe COVID-19: a prospective observational study.

Leukemia. 2021-4

[10]
Baricitinib restrains the immune dysregulation in patients with severe COVID-19.

J Clin Invest. 2020-12-1

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