Baricitinib may warrant further investigation for COVID-19 pneumonia
medwireNews: Preliminary findings from an observational study suggest that add-on treatment with baricitinib may improve respiratory function in patients with moderate-to-severe SARS-CoV-2 pneumonia.
“Janus kinase (JAK) inhibitors, particularly baricitinib, a drug that is currently used to treat [rheumatoid arthritis], may be beneficial in treating SARS-CoV-2 infection” because baricitinib “interrupts the passage and intracellular assembly of SARS-CoV-2 into the target cells via disruption of AAK1 signalling [and] also reduces inflammation in patients with acute respiratory distress syndrome,” explain the researchers.
The study involved 112 patients hospitalized with COVID-19 pneumonia at the General University Hospital of Albacete in Spain who had a ratio of arterial oxygen partial pressure to fractional inspired oxygen (FiO2) of less than 200 mmHg. Patients were given the local standard treatment of lopinavir, ritonavir, and hydroxychloroquine, combined with 3 days of pulse corticosteroid therapy followed by prednisone with or without baricitinib. The JAK inhibitor was given in a low-dose (4 mg on day 1 followed by 2 mg/day) or high-dose (4 mg/day) regimen for 5–10 days.
As reported in Rheumatology, the 62 patients treated with baricitinib experienced a significantly greater improvement in the ratio of oxygen saturation to FiO2 from the time of hospitalization to discharge than the 50 patients in the control group, with a mean difference of 49 mmHg after adjustment for inverse propensity score weighting.
Moreover, a significantly lower proportion of patients in the baricitinib versus the control group required supplemental oxygen at discharge (25.8 vs 62.0%) and 1 month later (12.9 vs 28.0%).
Jose Luis Rodriguez-Garcia (General University Hospital of Albacete) and colleagues note, however, that rates of death, intensive care unit (ICU) admission, and a composite of both outcomes were comparable in the two groups.
When patients in the baricitinib group were categorized according to dose, the researchers say that those given the JAK inhibitor at a high dose experienced a greater improvement in respiratory function than those given the lower dose, whereas there were “no differences” in the proportion of patients requiring supplemental oxygen at discharge or after 1 month.
Taken together, these findings suggest that baricitinib plus corticosteroids is a “reasonably efficacious” option for people with COVID-19 pneumonia who are at risk for ICU admission or mechanical ventilation, say Rodriguez-Garcia et al.
However, they emphasize that “[r]esults from randomized control clinical trials are indeed needed to confirm these preliminary results and to further inform guidelines and clinical decisions.”
The team also points out that “[b]aricitinib must be used with caution in patients with risk factors for deep vein thrombosis and/or pulmonary embolism, stressing that “its use could be considered of risk in SARS-CoV-2 infection, where the high incidence of thromboembolic events suggests an important role of SARS-CoV-2-induced coagulopathy.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group
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