Ruxolitinib plus standard of care in severe hospitalized adults with severe fever with thrombocytopenia syndrome (SFTS): an exploratory, single-arm trial
-
Published:2024-05-20
Issue:1
Volume:22
Page:
-
ISSN:1741-7015
-
Container-title:BMC Medicine
-
language:en
-
Short-container-title:BMC Med
Author:
Wen Sai, Xu Nannan, Zhao Lianhui, Yang Lulu, Yang Hui, Chang Caiyun, Wang Shanshan, Qu Chunmei, Song Li, Zou Wenlu, He Yishan, Wang GangORCID
Abstract
Abstract
Background
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infectious disease, and its morbidity and mortality are increasing. At present, there is no specific therapy available. An exacerbated IFN-I response and cytokine storm are related to the mortality of patients with SFTS. Ruxolitinib is a Janus kinase (JAK) 1/2 inhibitor that can block proinflammatory cytokines and inhibit the type I IFN pathway. We aimed to explore the use of ruxolitinib plus standard of care for severe SFTS.
Methods
We conducted a prospective, single-arm study of severe SFTS. We recruited participants aged 18 years or older who were admitted to the hospital with laboratory-confirmed severe SFTS and whose clinical score exceeded 8 points within 6 days of symptom onset. Participants received oral ruxolitinib (10 mg twice a day) for up to 10 days. The primary endpoint was 28-day overall survival. The secondary endpoints included the proportion of participants who needed intensive care unit (ICU) admission, total cost, changes in neurologic symptoms and clinical laboratory parameters, and adverse events (AEs) within 28 days. A historical control group (HC group, n = 26) who met the upper criteria for inclusion and hospitalized from April 1, 2021, to September 16, 2022, was selected and 1:1 matched for baseline characteristics by propensity score matching.
Results
Between Sep 16, 2022, and Sep 16, 2023, 26 participants were recruited into the ruxolitinib treatment group (RUX group). The 28-day overall mortality was 7.7% in the RUX group and 46.2% in the HC group (P = 0.0017). There was a significantly lower proportion of ICU admissions (15.4% vs 65.4%, p < 0.001) and total hospitalization cost in the RUX group. Substantial improvements in neurologic symptoms, platelet counts, hyperferritinemia, and an absolute decrease in the serum SFTS viral load were observed in all surviving participants. Treatment-related adverse events were developed in 6 patients (23.2%) and worsened in 8 patients (30.8%), and no treatment-related serious adverse events were reported.
Conclusions
Our findings indicate that ruxolitinib has the potential to increase the likelihood of survival as well as reduce the proportion of ICU hospitalization and being tolerated in severe SFTS. Further trials are needed.
Trail registration
ChiCTR2200063759, September 16, 2022.
Publisher
Springer Science and Business Media LLC
Reference33 articles.
1. Yu XJ, Liang MF, Zhang SY, Liu Y, Li JD, Sun YL, Zhang L, Zhang QF, Popov VL, Li C, et al. Fever with thrombocytopenia associated with a novel bunyavirus in China. N Engl J Med. 2011;364(16):1523–32. 2. Kobayashi Y, Kato H, Yamagishi T, Shimada T, Matsui T, Yoshikawa T, Kurosu T, Shimojima M, Morikawa S, Hasegawa H, et al. Severe fever with thrombocytopenia syndrome, Japan, 2013–2017. Emerg Infect Dis. 2020;26(4):692–9. 3. Tran XC, Yun Y, Van An L, Kim SH, Thao NTP, Man PKC, Yoo JR, Heo ST, Cho NH, Lee KH. Endemic Severe fever with thrombocytopenia syndrome. Vietnam Emerg Infect Dis. 2019;25(5):1029–31. 4. Rattanakomol P, Khongwichit S, Linsuwanon P, Lee KH, Vongpunsawad S, Poovorawan Y. Severe fever with thrombocytopenia syndrome virus infection, Thailand, 2019–2020. Emerg Infect Dis. 2022;28(12):2572–4. 5. International Committee on Taxonomy of Viruses. Taxon details: severe fever with thrombocytopenia syndrome virus. [https://ictv.global/taxonomy/taxondetails?taxnode_id=202100166].
|
|