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London: A class of drugs known as Janus kinase, or JAK, inhibitors, which work by slowing down the immune system, should be the first-line therapy for patients hospitalized for COVID-19, researchers reported in The Lancet Respiratory Medicine. The researchers analyzed individual outcomes of nearly 13,000 adults hospitalized for COVID who participated in 16 randomized trials comparing JAK inhibitors to other drugs or placebos between May 2020 and March 2022. Overall, 11.7 per cent of patients who received JAK inhibitors died by day 28, compared with 13.2 per cent of those who received other treatments such as the steroid dexamethasone or medications that block the signaling of the inflammatory protein IL-6. After accounting for individual risk factors, the odds of death by day 28 were 33 per cent lower in the JAK inhibitor group. "These results should inform World Health Organization COVID-19 treatment guidelines, both in the USA and Europe," an editorial published with the study said. "Although the pandemic has passed and COVID-19 is not nearly as rampant as it was previously, delays in disseminating and adopting best-evidence treatment practices can only be harmful." JAK inhibitors include Pfizer's Xeljanz (tofacitinib), Eli Lilly's Olumiant (baricitinib), and AbbVie's Rinvoq (upadacitinib). JAK inhibitors also decreased the need for new mechanical ventilation or other respiratory support, and allowed for faster discharge from hospital by about 1 day, with fewer serious adverse events. The findings were true regardless of patients' COVID vaccination status. "The certainty of the authors' conclusion that JAK inhibitory therapy for the treatment of patients admitted to hospital for COVID-19 provides a significant mortality benefit is further supported when the analysis is limited to placebo-controlled studies," the editorial says. FOR VERY LARGE FETUSES, EARLY INDUCTION MAY BE BENEFICIAL When a near-term fetus is expected to be larger than most other newborns at birth, it might be safer to induce labor a bit ahead of the due date, new data suggest. Births of large babies can be complicated by shoulder dystocia, an emergency situation in which their shoulders become impacted on the mother's pubic bones after their head has emerged, preventing the rest of the body from being delivered spontaneously. To see if inducing labor ahead of schedule would reduce the risk of shoulder dystocia, researchers recruited 2,893 women whose fetuses appeared on ultrasound to be larger than 90 per cent of other similarly-aged fetuses. They randomly assigned the women to receive standard care or induction between 38 weeks and 38-weeks-and-four-days of gestation. Induction was expected to result in an earlier birth and a lower birth weight than standard care. Overall, in the so-called Big Baby Trial, there was no difference between the groups in rates of shoulder dystocia, probably because many of the women in the standard care group delivered before 38 weeks, and so their babies were smaller than predicted. When the analysis was limited to women who did not deliver before 38 weeks, shoulder dystocia occurred in 2.3% of babies in the induction group versus 3.7 per cent of those in the standard care group. The induction group delivered on average about 8 days earlier, and their babies weighed about 8 ounces (213 grams) less, compared to the usual-care group. After accounting for individual risk factors, the odds of shoulder dystocia were 38% lower in the induction group versus usual care in women whose pregnancies lasted beyond 38 weeks. Induction of labor was also associated with a lower likelihood of cesarean delivery and fewer maternal complications, researchers reported in The Lancet. An editorial published with the report notes, "The Big Baby Trial joins an accumulating body of literature... indicating that induction of labor either does not alter or might reduce the risk for needing cesarean delivery" when a larger fetus is suspected. NEW BED NET TREATMENT TARGETS MALARIA PARASITES IN MOSQUITOES Bed nets may once again become useful against malaria in endemic regions, with use of a chemical that targets the malaria-causing parasite in mosquitoes rather than the mosquitoes themselves, researchers reported on Wednesday in Nature. The use of long-lasting insecticides in bed nets significantly reduced malaria cases and deaths between 2000 and 2015, but the method eventually became less effective due to the rise of insecticide resistance. The researchers from the Harvard T. H. Chan School of Public Health in Boston screened 81 endochin-like quinolones (ELQs), a class of experimental antimalarial agents, and identified two that block the development of the malaria parasite by targeting a key protein in the parasite. The ELQs were effective even against mosquitoes that were resistant to traditional insecticides. "Malaria control desperately needs innovation," study co-author Dr. Flaminia Catteruccia said in a statement. "Our chemistry collaborators at Oregon Health and Science University were able to generate these compounds inexpensively, which would allow this approach to be integrated into existing bed net infrastructure at a competitive cost," study leader Alexandra Probst said in a statement. (Reporting by Nancy Lapid; additional reporting by Shawana Alleyne-Morris; Editing by Bill Berkrot)