If the meta-analysis was restricted to RECOVERY plus the three other trials of baricitinib, the RR would be 0♸1 (95% CI 0♷3–0♹1).
†These trials assessed a JAK inhibitor other than baricitinib. Subtotals or totals of (O–E) and of V yield inverse-variance weighted averages of the ln rate ratio values. Rate ratio is calculated by taking ln rate ratio to be (O–E)/V with normal variance 1/V, where V=Var (O–E). For the other trials, the O–E statistics and their variances are calculated from 2 × 2 tables. *For RECOVERY, the O–E and and its variance are calculated from the age-adjusted log RR and its standard error. Details of the individual studies, including the use of placebo or other treatments in the control group are shown in the appendix (p 62). Meta-analysis of mortality in randomised controlled trials of a JAK inhibitor in patients hospitalised with COVID-19 JAK=Janus kinase. This is an Open Access article under the CC BY 4.0 license. UK Research and Innovation (Medical Research Council) and National Institute of Health Research.Ĭopyright © 2022 The Author(s). The total randomised evidence to date suggests that JAK inhibitors (chiefly baricitinib) reduce mortality in patients hospitalised for COVID-19 by about one-fifth. In patients hospitalised with COVID-19, baricitinib significantly reduced the risk of death but the size of benefit was somewhat smaller than that suggested by previous trials. In RECOVERY, there was no significant excess in death or infection due to non-COVID-19 causes and no significant excess of thrombosis, or other safety outcomes. Including the results from RECOVERY in an updated meta-analysis of all nine completed trials (involving 11 888 randomly assigned patients and 1485 deaths) allocation to baricitinib or another JAK inhibitor was associated with a 20% proportional reduction in mortality (rate ratio 0♸0 95% CI 0♷2-0♸9 p<0♰001). This 13% proportional reduction in mortality was somewhat smaller than that seen in a meta-analysis of eight previous trials of a JAK inhibitor (involving 3732 patients and 425 deaths), in which allocation to a JAK inhibitor was associated with a 43% proportional reduction in mortality (rate ratio 0♵7 95% CI 0♴5-0♷2). Overall, 514 (12%) of 4148 patients allocated to baricitinib versus 546 (14%) of 4008 patients allocated to usual care died within 28 days (age-adjusted rate ratio 0♸7 95% CI 0♷7-0♹9 p=0♰28). At randomisation, 95% of patients were receiving corticosteroids and 23% were receiving tocilizumab (with planned use within the next 24 h recorded for a further 9%).
OLIVIA WILDE MORRISSEY SHIRT TRIAL
The RECOVERY trial is registered with ISRCTN (50189673) and ( NCT04381936) and is ongoing.īetween Feb 2 and Dec 29, 2021, from 10 852 enrolled, 8156 patients were randomly allocated to receive usual care plus baricitinib versus usual care alone.
A meta-analysis was done, which included the results from the RECOVERY trial and all previous randomised controlled trials of baricitinib or other JAK inhibitor in patients hospitalised with COVID-19. The primary outcome was 28-day mortality assessed in the intention-to-treat population. Eligible and consenting patients were randomly allocated (1:1) to either usual standard of care alone (usual care group) or usual care plus baricitinib 4 mg once daily by mouth for 10 days or until discharge if sooner (baricitinib group).
This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy ), is assessing multiple possible treatments in patients hospitalised with COVID-19 in the UK. We aimed to evaluate the use of baricitinib, a Janus kinase (JAK) 1-2 inhibitor, for the treatment of patients admitted to hospital with COVID-19.
0 kommentar(er)
