BTK inhibitors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): A systematic review

Michael Stack; Keith Sacco; Riccardo Castagnoli; Alicia A Livinski; Luigi D Notarangelo; Michail S Lionakis

doi:10.1016/j.clim.2021.108816

BTK inhibitors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): A systematic review

Clin Immunol. 2021 Sep:230:108816. doi: 10.1016/j.clim.2021.108816. Epub 2021 Aug 2.

Authors

Michael Stack¹, Keith Sacco², Riccardo Castagnoli¹, Alicia A Livinski³, Luigi D Notarangelo¹, Michail S Lionakis⁴

Affiliations

¹ Laboratory of Clinical Immunology and Microbiology, Immunodeficiency Genetics Section, NIAID, NIH, Bethesda, MD, USA.
² Laboratory of Clinical Immunology and Microbiology, Immunodeficiency Genetics Section, NIAID, NIH, Bethesda, MD, USA. Electronic address: keith.sacco@nih.gov.
³ Division of Library Services, Office of Research Services, National Institutes of Health, Bethesda, MD, USA.
⁴ Laboratory of Clinical Immunology and Microbiology, Fungal Pathogenesis Section, NIAID, NIH, Bethesda, MD, USA.

Abstract

Introduction: The Bruton tyrosine kinase (BTK) regulates B cell and macrophage signaling, development, survival, and activation. Inhibiting BTK has been hypothesized to ameliorate lung injury in patients with severe COVID-19, however clinical outcome data is inconclusive.

Objective: To evaluate the clinical outcomes of BTK inhibitors (BTKinibs) in patients with COVID-19.

Evidence review: We searched PubMed, Embase, and Web of Science:Core on December 30, 2020. Clinical studies with at least 5 COVID-19 patients treated with BTKinibs were included. Case reports and reviews were excluded.

Findings: 125 articles were identified, 6 of which met inclusion criteria. The most common clinical outcomes measured were oxygen requirements (4/6) and hospitalization rate or duration (3/6). Three studies showed decreased oxygen requirements in patients who started or continued BTKinibs. All three studies that evaluated hospitalization rate or duration found favorable outcomes in those on BTKinibs.

Conclusions and relevance: BTKinib use was associated with decreased oxygen requirements and decreased hospitalization rates and duration.

Keywords: Acalabrutinib; Acute respiratory distress syndrome; Bruton's tyrosine kinase; COVID-19; Cytokine storm; Hospitalization; Ibrutinib; SARS-CoV-2; X-linked agammaglobulinemia.

Published by Elsevier Inc.