Clinical Efficacy and Adverse Events of Baricitinib Treatment for Coronavirus Disease-2019 (COVID-19): A Systematic Review and Meta-Analysis

Background: The benefits of baricitinib, which is a Janus kinase inhibitor, in coronavirus disease-2019 (COVID-19) are inadequately defined. We performed a systematic review and meta-analysis of randomised, controlled trials and observational studies of baricitinib to determine its clinical efficacy and adverse events in patients with COVID-19.Methods: Major databases were searched from 2019 to 2021 inclusive. The primary outcome was the coefficient of mortality. We also compared increasing different doses of baricitinib, intensive care unit admission, the requirement for mechanical ventilation, the oxygenation index, and adverse events between baricitinib treatment and placebo or other treatments.Findings: Twelve studies of 3564 patients were included and assessed qualitatively (Jadad and Newcastle–Ottawa Scale scores). Baricitinib effectively improved the mortality rate (relative risk of mortality = 0.56; 95% confidence interval: 0.46–0.69; P < 0.00001; I2 = 2%), and this result was unchanged by subgroup analysis. Baricitinib also improved intensive care unit admission, the requirement for invasive mechanical ventilation, and the oxygenation index. Data from these studies also showed that baricitinib slightly reduced the risk of adverse events. With regard to the choice of the drug dosage of baricitinib, the high-dose group appeared to have additional benefits for clinical efficacy.Interpretation: Our study shows that baricitinib may be a promising, safe, and effective anti-severe acute respiratory syndrome-coronavirus-2 drug candidate, with the advantages of a low cost, easy production, and convenient storage.Funding Information: We gratefully acknowledge the financial supports by the Basic research program of Guangzhou (202102010224), Clinical Transformation program of the first affiliated hospital of Guangzhou medical university (ZH201802, ZH201914), High-level university program of Guangzhou medical university (2017(160)) and Opening Project of State Key Laboratory of Respiratory Disease (SKLRD-0P-202115).Declaration of Interests: The authors have no potential conflict of interest to disclose.