Effectiveness and Safety of Baricitinib as a Covid-19 Drug Candidate: A Systematic Review
Abstract
Baricitinib is an approved selective JAK1/JAK2 inhibitor that can potentially inhibit IL-6 as the primary driver of COVID-19-related cytokine storm syndrome. Therefore, this study aimed to assess the effectiveness and safety of baricitinib therapy in COVID-19 patients. It was reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search for eligible articles reporting the efficacy and safety of baricitinib on COVID-19 patients, published up to May 2021, was conducted using PubMed and Embase. The research protocol was registered at PROSPERO (CDR42021235282), and data were presented in a metasynthetic (descriptive) manner. Out of 878 identified articles, seven were eligible and consisted of three randomized clinical trials, one quasi-experimental study, two before-after (pre-post) studies, and one cross-sectional study. The articles suggested that baricitinib could improve the clinical conditions of COVID-19 patients indicated by negative PCR test results, improve breathing quality, and decrease: ICU requirements, length of hospital stay, as well as the risk of death. The trial studies showed that this inhibitor works better with a loading dose of 8 mg, continued with 4 mg daily. Baricitinib could also produce synergistic effects with standard therapy such as corticosteroid and remdesivir. Therefore, it is a promising candidate therapy for COVID-19 patients, but since the number and methodological quality of the studies are low, further and better research is needed to ascertain its potential use on COVID-19.
Keywords: Baricitinib, COVID-19, JAK1/2 inhibitor
Efektivitas dan Keamanan Baricitinib sebagai Kandidat Obat Covid-19: Tinjauan Sistematis
Abstrak
Baricitinib adalah inhibitor selektif JAK1 JAK2 yang dapat menghambat IL-6 sebagai pemicu utama terjadinya sindrom badai sitokin terkait COVID-19. Tinjauan sistematis ini dilakukan untuk menilai efektivitas dan keamanan terapi baricitinib pada pasien COVID-19. Kami melaporkan penelitian ini dengan mengikuti pedoman Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). Kami menggunakan mesin pencari PubMed dan Embase untuk mencari artikel yang melaporkan efektivitas dan keamanan baricitinib pada pasien COVID-19, yang diterbitkan hingga Mei 2021. Protokol penelitian ini telah terdaftar di PROSPERO (CDR42021235282). Data disajikan secara metasintetik (deskriptif). Di antara 878 artikel yang teridentifikasi, ada tujuh artikel yang memenuhi syarat yang terdiri dari tiga artikel uji klinis acak terkendali, satu studi kuasi-eksperimental, dua studi sebelum-sesudah (pra-pasca) dan satu studi cross-sectional. Semua artikel menyatakan bahwa baricitinib dapat memperbaiki kondisi klinis pasien COVID-19 yang ditunjukkan dengan hasil tes PCR negatif, meningkatkan kualitas pernapasan, dan menurunkan: kebutuhan ICU, lama rawat inap, dan resiko kematian. Baricitinib tidak menyebabkan efek samping yang serius. Hasil uji klinis menunjukkan bahwa baricitinib bekerja lebih baik dengan pemberian loading dose 8 mg lalu dilanjutkan dengan baricitinib 4 mg setiap hari dibandingkan tanpa loading dose baricitinib. Baricitinib juga menghasilkan efek sinergistik jika dikombinasikan dengan terapi standar seperti kortikosteroid dan remdesivir. Oleh karena itu, dapat disimpulkan bahwa baricitinib adalah kandidat terapi yang menjanjikan untuk pasien COVID-19. Namun, karena jumlah dan kualitas metodologi penelitiannya rendah, penelitian lebih lanjut dan lebih baik secara metodologi masih dibutuhkan untuk memastikan potensi penggunaan baricitinib pada COVID-19.
Kata kunci: Baricitinib, COVID-19, inhibitor JAK1/2
Keywords
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DOI: https://doi.org/10.15416/ijcp.2022.11.1.78
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