Singh Pawan Kumar, Sharma Vinod Kumar, Lalwani Lokesh Kumar, Chaudhry Dhruva, Govindagoudar Manjunath B, Sriram Chaudhari Pramod, Ahuja Aman
Department of Pulmonary and Critical Care Medicine, Pt BDS Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
Department of Respiratory Medicine, Pt BDS Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
Turk J Emerg Med. 2023 Jun 26;23(3):149-155. doi: 10.4103/tjem.tjem_363_22. eCollection 2023 Jul-Sep.
Ongoing symptomatic coronavirus disease 2019 (OSC) is defined as persistent symptoms beyond 4 weeks of acute illness. OSC leads to prolonged hospitalization and oxygen dependence. We aimed to find the outcome of Janus kinase inhibitors (JAKi) as a steroid-sparing agent to treat OSC.
In this single-center case-controlled study comparing JAKi and corticosteroids in OSC cases, data of 41 cases out of 86 were included - 21 in the JAKi group and 20 in the corticosteroid group from 4 weeks of acute illness to the next 4 weeks. Clinical parameters and inflammatory markers were recorded. The primary outcome was to compare the proportion of patients who were able to maintain oxygen saturation ≥95% with any oxygen supplementation in the two groups.
The baseline clinical and demographic characteristics were similar in the two groups. The age was 53.65 ± 9.8 years and 51.48 ± 14.0 years in the corticosteroid group and JAKi group, respectively. At the baseline, 85% of patients in the corticosteroid group and 85.8% in the JAKi group were on oxygen support. The most common symptom in both groups was breathlessness followed by cough. Twenty percent of patients in the JAKi group received baricitinib and the remaining were given tofacitinib. At the time of follow-up, the majority of cases had a significant reduction in C-reactive protein (CRP) and D-dimer; however, the change in CRP and D-dimer was similar in both groups. The number of patients off oxygen support at 4 weeks was higher in the JAKi group (85% in the corticosteroid group vs. 95.2% in the JAKi group, = 0.269), and the median time to liberation from oxygen support was significantly lower in JAKi group (19 days in corticosteroid group vs. 9 days in JAKi group, < 0.001). The frequency of any adverse event was also higher in the corticosteroid group (70% vs. 23.8%, = 0.003).
JAKi can be used as immunomodulatory drugs in hypoxic OSC cases having evidence of ongoing inflammation.
持续性症状的2019冠状病毒病（OSC）定义为急性病4周后仍持续存在的症状。OSC导致住院时间延长和氧依赖。我们旨在研究 Janus激酶抑制剂（JAKi）作为一种类固醇节省剂治疗OSC的效果。
在这项单中心病例对照研究中，比较JAKi和皮质类固醇在OSC病例中的应用，纳入了86例中的41例数据——从急性病4周后到接下来的4周，JAKi组21例，皮质类固醇组20例。记录临床参数和炎症标志物。主要结局是比较两组中在任何氧补充情况下能够维持氧饱和度≥95%的患者比例。
两组的基线临床和人口统计学特征相似。皮质类固醇组和JAKi组的年龄分别为53.65±9.8岁和51.48±14.0岁。基线时，皮质类固醇组85%的患者和JAKi组85.8%的患者接受氧支持。两组中最常见的症状是呼吸困难，其次是咳嗽。JAKi组20%的患者接受巴瑞替尼，其余患者接受托法替布。在随访时，大多数病例的C反应蛋白（CRP）和D-二聚体显著降低；然而，两组中CRP和D-二聚体的变化相似。JAKi组在4周时脱离氧支持的患者数量更高（皮质类固醇组为85%，JAKi组为95.2%，P = 0.269），JAKi组脱离氧支持的中位时间显著更短（皮质类固醇组为19天，JAKi组为9天，P < 0.001）。皮质类固醇组任何不良事件的发生率也更高（70%对23.8%，P = 0.003）。
JAKi可作为有持续炎症证据的低氧OSC病例的免疫调节药物。
