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Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. It affects multiple organ systems and is associated with significant morbidity and mortality. The treatment for SLE primarily aims at controlling and remitting the disease. Baricitinib is a kinase inhibitor that selectively inhibits JAK1 and JAK2 enzymes. Recently this drug is being investigated as a potential therapeutic option for SLE. Objective: To analyze the efficacy of baricitinib in treating SLE. Methods: Search of databases identified relevant studies that reported the efficacy of baricitinib. Data of patient characteristics, intervention details, and outcomes was extracted. The data from the studies were pooled using a random-effects model. The odds ratio with their respective 95 % confidence intervals (CI) were calculated to analyze the results. A p value of <0.05 was considered statistically significant. Results: 3 RCTs were included in the analysis. 1849 patients were extracted from the included studies, most of the participants were females with a mean age of 43 years. The studies showed a significant effect of Baricitinib 4 mg in achieving SRI-4 [OR = 1.42 (95 % CI: 1.01, 2.00); p = 0.04]. There was no significant association of Baricitinib 2 mg in achieving SRI-4. Both dosages of the drug did not have any significant association in achieving LLDAS as compared to placebo. Serious adverse side effects were significantly associated with Bar 4 mg as compared to Bar 2 mg. Conclusion: Our meta-analysis suggests that baricitinib might be a potential treatment option for SLE. Further large-scale clinical trials are needed to confirm our findings. Potential side effects should also be considered while the administration of this drug.
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OBJECTIVES: Worldwide, an estimated 10 million adults annually experience significant myocardial injury after non-cardiac surgery. Our aim is to assess whether preoperative and postoperative serum B-type natriuretic peptides levels (BNP) could be used as a predictor of postoperative complications in hypertensive and diabetic patients post non-cardiac surgery. DESIGN: Prospective observational study. SETTING: Single tertiary-care centre in northern India. PARTICIPANTS: This study included 260 adult participants with known hypertension and diabetes who were planned for elective non-cardiac surgery. INTERVENTIONS: A preoperative BNP level (baseline BNP) was measured within 24 hours of surgery and another postoperative BNP level was measured within 24 hours of surgery. MAIN OUTCOME MEASURES: The primary outcome was the change in BNP levels (delta BNP) between the postoperative and the preoperative BNP levels (baseline BNP) with respect to the baseline BNP and the development of postoperative complications within 30 days of surgery. RESULTS: The study established a correlation between delta BNP and baseline BNP (Pearson's correlation coefficient=0.60; p=0.01). Our study found an increased serum BNP both in the preoperative period and the postoperative period in the patient group that developed complications, respectively (152.02 pg/mL±106.56 vs 44.90 pg/mL±44.22; t=4.120; p≤0.001); (313.99 pg/mL±121.29 vs 83.95 pg/mL±70.19; t=7.73; p≤0.001). CONCLUSIONS: We found that an increased serum baseline and postoperative BNP is potentially important predictor for the development of postoperative complications. Serum BNP has the potential to emerge as a cost-effective test for risk-stratification for postoperative complications in patients undergoing non-cardiac surgery. It has promising prognostic advantages including modification of surgical procedures, deferral of surgery and the ability to tailor therapy postoperatively.
