Selvaraj Vijairam, Finn Arkadiy, Lal Amos, Khan Mohammad Saud, Dapaah-Afriyie Kwame, Carino Gerardo P
Department of Medicine, Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
The Miriam Hospital, Providence, RI, USA.
EClinicalMedicine. 2022 Jul;49:101489. doi: 10.1016/j.eclinm.2022.101489. Epub 2022 Jun 3.
To date, only dexamethasone and tocilizumab have been shown to reduce mortality in patients with COVID-19. Baricitinib is a Janus kinase 1/2 inhibitor with known anti-inflammatory and anti-viral properties. We performed a meta-analysis of RCTs assessing the role of baricitinib in hospitalised patients with COVID-19.
Electronic databases such as MEDLINE, EMBASE, and Cochrane Central were searched up until March 31, 2022, for RCTs evaluating the efficacy of baricitinib in hospitalised patients with COVID-19. The outcomes assessed were 28-day mortality, progression to invasive mechanical ventilation (IMV) or ECMO, progression to respiratory failure needing positive pressure ventilation, IMV or death, duration of hospitalisation and time to discharge. The meta-analysis was registered in the PROSPERO database (CRD42022314579).
Four studies (with 10,815 patients) were included in the analysis. Pooled analysis using random-effects model showed a statistically significant reduction in 28-day mortality (OR 0.69, 95% CI 0.50-0.94; p=0.04, I=65%) and composite outcome of progression to severe disease needing positive pressure ventilation, IMV or death (OR 0.89, 95% CI 0.80-0.99, p= 0.03, I=0%). There was a favorable trend towards reduced progression to IMV or ECMO (OR 0.76, 95% CI 0.58-1.01; p=0.06, I=49%) in the baricitinib arm compared to standard therapy, even though it was not statistically significant. Statistical significance was achieved for all outcomes with fixed-effects model analysis.
In hospitalised patients with COVID-19, baricitinib was associated with reduced 28-day mortality although there was not a statistically significant reduction in progression to IMV or ECMO. Baricitinib used in conjunction with standard of care treatments is associated with improved mortality in hospitalised patients with COVID-19 disease.
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迄今为止，仅地塞米松和托珠单抗已被证明可降低新冠肺炎患者的死亡率。巴瑞替尼是一种具有已知抗炎和抗病毒特性的 Janus 激酶 1/2 抑制剂。我们对评估巴瑞替尼在住院新冠肺炎患者中作用的随机对照试验进行了荟萃分析。
检索了 MEDLINE、EMBASE 和 Cochrane 中心等电子数据库，截至 2022 年 3 月 31 日，查找评估巴瑞替尼对住院新冠肺炎患者疗效的随机对照试验。评估的结局包括 28 天死亡率、进展为有创机械通气（IMV）或体外膜肺氧合（ECMO）、进展为需要正压通气、IMV 或死亡的呼吸衰竭、住院时间和出院时间。该荟萃分析已在 PROSPERO 数据库（CRD42022314579）中注册。
四项研究（共 10815 名患者）纳入分析。使用随机效应模型的汇总分析显示，28 天死亡率有统计学显著降低（比值比 0.69，95%置信区间 0.50 - 0.94；p = 0.04，I² = 65%），以及进展为需要正压通气、IMV 或死亡的严重疾病的复合结局有统计学显著降低（比值比 0.89，95%置信区间 0.80 - 0.99，p = 0.03，I² = 0%）。与标准治疗相比，巴瑞替尼组进展为 IMV 或 ECMO 有降低的有利趋势（比值比 0.76，95%置信区间 0.58 - 1.01；p = 0.06，I² = 49%），尽管无统计学显著性。固定效应模型分析的所有结局均达到统计学显著性。
在住院新冠肺炎患者中，巴瑞替尼与降低 28 天死亡率相关，尽管进展为 IMV 或 ECMO 无统计学显著降低。巴瑞替尼与标准治疗联合使用可改善住院新冠肺炎患者的死亡率。
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