Baricitinib improves respiratory function in patients treated with corticosteroids for SARS-CoV-2 pneumonia: an observational cohort study

Rheumatology (Oxford). 2021 Jan 5;60(1):399-407. doi: 10.1093/rheumatology/keaa587.

Abstract

Objectives: The Janus kinase (JAK) inhibitor baricitinib may block viral entry into pneumocytes and prevent cytokine storm in patients with SARS-CoV-2 pneumonia. We aimed to assess whether baricitinib improved pulmonary function in patients treated with high-dose corticosteroids for moderate to severe SARS-CoV-2 pneumonia.

Methods: This observational study enrolled patients with moderate to severe SARS-CoV-2 pneumonia [arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (FiO2) <200 mmHg] who received lopinavir/ritonavir and HCQ plus either corticosteroids (CS group, n = 50) or corticosteroids and baricitinib (BCT-CS group, n = 62). The primary end point was the change in oxygen saturation as measured by pulse oximetry (SpO2)/FiO2 from hospitalization to discharge. Secondary end points included the proportion of patients requiring supplemental oxygen at discharge and 1 month later. Statistics were adjusted by the inverse propensity score weighting (IPSW).

Results: A greater improvement in SpO2/FiO2 from hospitalization to discharge was observed in the BCT-CS vs CS group (mean differences adjusted for IPSW, 49; 95% CI: 22, 77; P < 0.001). A higher proportion of patients required supplemental oxygen both at discharge (62.0% vs 25.8%; reduction of the risk by 82%, OR adjusted for IPSW, 0.18; 95% CI: 0.08, 0.43; P < 0.001) and 1 month later (28.0% vs 12.9%, reduction of the risk by 69%, OR adjusted for IPSW, 0.31; 95% CI: 0.11, 0.86; P = 0.024) in the CS vs BCT-CS group.

Conclusions: . In patients with moderate to severe SARS-CoV-2 pneumonia a combination of baricitinib with corticosteroids was associated with greater improvement in pulmonary function when compared with corticosteroids alone.

Trial registration: European Network of Centres for Pharmacoepidemiology and Pharmacovigilance, ENCEPP (EUPAS34966, http://www.encepp.eu/encepp/viewResource.htm? id = 34967).

Keywords: COVID-19; SARS-CoV-2; baricitinib; corticosteroids.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Antiviral Agents / therapeutic use
  • Azetidines / therapeutic use*
  • COVID-19 / drug therapy*
  • COVID-19 / metabolism
  • COVID-19 / physiopathology
  • Cohort Studies
  • Drug Combinations
  • Drug Therapy, Combination
  • Endothelium, Vascular
  • Enzyme Inhibitors / therapeutic use
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism
  • Glucocorticoids / therapeutic use*
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Hypoxia / therapy*
  • Immunoglobulins, Intravenous / therapeutic use
  • Immunologic Factors / therapeutic use
  • Interferon beta-1b / therapeutic use
  • Janus Kinase Inhibitors / therapeutic use*
  • Lopinavir / therapeutic use
  • Lung / blood supply
  • Male
  • Methylprednisolone / therapeutic use*
  • Middle Aged
  • Oximetry
  • Oxygen Inhalation Therapy / statistics & numerical data*
  • Prospective Studies
  • Purines / therapeutic use*
  • Pyrazoles / therapeutic use*
  • Ritonavir / therapeutic use
  • SARS-CoV-2
  • Severity of Illness Index
  • Sulfonamides / therapeutic use*

Substances

  • Antiviral Agents
  • Azetidines
  • Drug Combinations
  • Enzyme Inhibitors
  • Fibrin Fibrinogen Degradation Products
  • Glucocorticoids
  • Immunoglobulins, Intravenous
  • Immunologic Factors
  • Janus Kinase Inhibitors
  • Purines
  • Pyrazoles
  • Sulfonamides
  • fibrin fragment D
  • lopinavir-ritonavir drug combination
  • Interferon beta-1b
  • Lopinavir
  • Hydroxychloroquine
  • baricitinib
  • Ritonavir
  • Methylprednisolone

Supplementary concepts

  • COVID-19 drug treatment