The impact of Ruxolitinib therapy on mortality in Coronavirus disease-2019 patients treated on intensive care unit – a retrospective data analysis
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Philipps-Universität Marburg
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In 2019 the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated disease coronavirus disease-2019 (Covid-19) emerged in China leading to a global health crisis. A significant challenge was the treatment of the acute respiratory distress syndrome (ARDS), a condition associated with the severe form of the disease. A cytokine storm, an overshooting reaction of the immune system, was identified as part of its underlying pathomechanism. Ruxolitinib, a drug that has been successfully used to treat conditions associated with an overactive immune response, has been demonstrated to inhibit the januskinase/signal transducers and activators of transcription (JAK/STAT) pathway, an important pathway in cytokine regulation. Consequently, Ruxolitinib has been trialled in a variety of studies investigating potential treatment options for coronavirus disease 2019.
This study provides an overview of Ruxolitinib therapy in the context of coronavirus disease-2019 in a cohort of patients with severe disease who were primarily invasively ventilated. Data from 137 adult patients (mean age 64 years, standard deviation 11.5, 70 % male) diagnosed with coronavirus disease-2019, who were treated on intensive care units at Klinikum Kassel between February 2020 and March 2021 were retrospectively analysed. Patients who received only low flow oxygen/room air were excluded. Patients were split into two groups. The treatment group (n = 67) received Ruxolitinib for a minimum of three days, whereas the control group (n = 70) received standard of care only. The primary objective was to analyse mortality and survival rates. The results were compared between both groups. Secondary outcomes included the length of intensive care/hospital stay, the impact of Ruxolitinib on the duration of invasive ventilation and the progression of pro-inflammatory markers during the treatment with Ruxolitinib among others.
The in-hospital mortality rate for the treatment group was 47.76 % (32/67), while the equivalent mortality rate for the control group was 41.43 % (29/70). A subgroup analysis of patients that were treated with Ruxolitinib and veno-venous extracorporeal membrane oxygenation (vv ECMO) (n = 42) revealed a mortality rate of 69.05 %. In the same group without extracorporeal membrane oxygenation, the mortality rate was 12 %. The log-rank test demonstrated a statistically significant survival difference between the two groups
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(χ² = 12.7 p<0.001). The median estimated survival in the treatment group was 27 days, in contrast to 15 days in the control group. The hazard ratio for death was elevated in invasively ventilated patients (hazard ratio 3.7, 95 % confidence interval 1.54-8.88; p=0.003). None of the non-invasively ventilated patients died under the Ruxolitinib therapy. Ruxolitinib was unable to shorten the median time spent on intensive care unit (treatment group 18 days (interquartile range 13), vs. control group 8 days (interquartile range 7.75); p<0.001) or the length of hospitalisation, compared to the control group. The median duration of invasive ventilation was longer in the Ruxolitinib group than in the control group (treatment group 20.5 days (interquartile range 18) vs. control group 6.5 days (interquartile range 8.25); p<0.001). A downward trend was observed for Interleukin-6 and C-reactive protein. No signs of toxicity were identified under the therapy with Ruxolitinib.
The present study demonstrates that Ruxolitinib was unable to improve mortality in patients with severe organ dysfunction and veno-venous extracorporeal membrane oxygenation. However, it suggests the necessity for further investigation into the effect of Ruxolitinib in patients with severe disease lacking extracorporeal membrane support. Findings confirm recent investigations on the impact of ventilation on mortality. The absence of death in patients receiving Ruxolitinib and non-invasive ventilation, is consistent with previous research and reinforces the concept of a limited time frame for Ruxolitinib administration. Previous research had indicated a reduction in mortality among invasively ventilated patients undergoing Ruxolitinib therapy; however, this study was unable to confirm these findings. The aforementioned results concerning pro-inflammatory markers are in accordance with recent findings in the literature. Although limited due to the retrospective study design, this study analysed a relatively large cohort of patients treated with Ruxolitinib and offers the opportunity for subgroup analysis. Due to the small number of cases in the subgroup, the reduction in mortality described, can only be seen as a trend. The analysis of the current data suggests that the administration of Ruxolitinib in the described setting must be critically discussed. However, to come to a definitive conclusion, further, at best prospective research is required.
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Created: 2025Issued: 2025-08-11Updated: 2025-08-11
Faculty
Medizin
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Philipps-Universität Marburg
Language
eng
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DoctoralThesis
Keywords
Diese Studie gibt einen Überblick über die Ruxolitinib-Therapie als Behandlungsansatz der Coronavirus-Erkrankung-2019 bei schwer erkranktenzumeist invasiv beatmeten PatientenThis study provides an overview of Ruxolitinib therapy in the context of coronavirus disease-2019 in a cohort of patients with severe disease who were primarily invasively ventilated.
DFG-subjects
mortalityRuxolitinibCoronavirus disease-2019Covid-19intensive care unitICU
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610
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Mathusek, Amelie: The impact of Ruxolitinib therapy on mortality in Coronavirus disease-2019 patients treated on intensive care unit – a retrospective data analysis. : Philipps-Universität Marburg 2025-08-11. DOI: https://doi.org/10.17192/z2025.0426.
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This item has been published with the following license: In Copyright