JAK-inhibitors for coronavirus disease-2019 (COVID-19): a meta-analysis

Abstract

We analyzed reports on safety and efficacy of JAK-inhibitors in patients with coronavirus infectious disease-2019 (COVID-19) published between January 1st and March 6th 2021 using the Newcastle-Ottawa and Jadad scales for quality assessment. We used disease severity as a proxy for time when JAK-inhibitor therapy was started. We identified 6 cohort studies and 5 clinical trials involving 2367 subjects treated with ruxolitinib (N\u2009=\u20093) or baricitinib 45 (N\u2009=\u20098). Use of JAK-inhibitors decreased use of invasive mechanical ventilation (RR = 0.63; [95% Confidence Interval (CI), 0.47, 0.84]; P\u2009=\u20090.002) and had borderline impact on rates of intensive care unit (ICU) admission (RR = 0.24 [0.06, 1.02]; P\u2009=\u20090.05) and acute respiratory distress syndrome (ARDS; RR = 0.50 [0.19, 1.33]; P\u2009=\u20090.16). JAK-inhibitors did not decrease length of hospitalization (mean difference (MD) –0.18 [–4.54, 4.18]; P\u2009=\u20090.94). Relative risks of death for both drugs were 0.42 [0.30, 0.59] (P\u2009<\u20090.001), for ruxolitinib, RR = 0.33 (0.13, 0.88; P\u2009=\u20090.03) and for baricitinib RR = 0.44 (0.31, 0.63; P\u2009<\u20090.001). Timing of JAK-inhibitor treatment during the course of COVID-19 treatment may be important in determining impact on outcome. However, these data are not consistently reported.