Kow Chia Siang, Ramachandram Dinesh Sangarran, Hasan Syed Shahzad
, MPharm, is with the School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia.
, MSc, is with the School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
Can J Hosp Pharm. 2024 Jun 12;77(2):e3493. doi: 10.4212/cjhp.3493. eCollection 2024.
The pathophysiology of COVID-19 involves a signalling pathway based on the Janus kinases (JAKs) and the signal transducer and activator of transcription (STAT) family of proteins. As such, there has been growing interest in exploring JAK inhibitors as potential therapeutic agents for this disease.
To provide a comprehensive summary of the efficacy of JAK inhibitors in the treatment of COVID-19 through a systematic review and meta-analysis.
A systematic literature search was conducted in multiple electronic databases (PubMed, Scopus, and the Cochrane Central Register of Controlled Trials) and preprint repositories, without language restrictions, to identify relevant studies published up to December 31, 2023.
The primary outcome of interest was all-cause mortality. Randomized controlled trials (RCTs) investigating the administration of JAK inhibitors in patients with COVID-19 were included.
Through the systematic literature search, a total of 20 RCTs meeting the inclusion criteria were identified. A random-effects model was employed to estimate the pooled odds ratio for death with administration of a JAK inhibitor relative to non-administration of such an agent, with 95% confidence interval. Meta-analysis of these trials revealed a significant reduction in mortality among patients with COVID-19 who received JAK inhibitors relative to those who did not receive these agents (pooled odds ratio 0.70, 95% confidence interval 0.58-0.84).
The results of this systematic review and meta-analysis suggest that JAK inhibitors, specifically baricitinib, may address the urgent need for effective treatments in the ongoing COVID-19 pandemic by reducing the risk of death among affected patients. However, further research, including larger-scale RCTs, is needed to establish the efficacy and safety of other JAK inhibitors in the treatment of COVID-19 and to generate more robust evidence regarding their use in this specific patient population.
2019冠状病毒病（COVID-19）的病理生理学涉及基于Janus激酶（JAKs）和信号转导及转录激活因子（STAT）蛋白家族的信号通路。因此，人们越来越有兴趣探索JAK抑制剂作为这种疾病的潜在治疗药物。
通过系统评价和荟萃分析，全面总结JAK抑制剂治疗COVID-19的疗效。
在多个电子数据库（PubMed、Scopus和Cochrane对照试验中央登记册）和预印本库中进行了系统的文献检索，无语言限制，以识别截至2023年12月31日发表的相关研究。
感兴趣的主要结局是全因死亡率。纳入了调查JAK抑制剂在COVID-19患者中应用的随机对照试验（RCT）。
通过系统文献检索，共识别出20项符合纳入标准的RCT。采用随机效应模型估计使用JAK抑制剂与未使用该药物相比的死亡合并比值比，并给出95%置信区间。对这些试验的荟萃分析显示，与未接受JAK抑制剂的COVID-19患者相比，接受JAK抑制剂的患者死亡率显著降低（合并比值比0.70，95%置信区间0.58 - 0.84）。
这项系统评价和荟萃分析的结果表明，JAK抑制剂，特别是巴瑞替尼，可能通过降低受影响患者的死亡风险，满足当前COVID-19大流行中对有效治疗的迫切需求。然而，需要进一步的研究，包括更大规模的RCT，以确定其他JAK抑制剂治疗COVID-19的疗效和安全性，并就其在这一特定患者群体中的使用产生更有力的证据。
