EFFICACY OF BARICITINIB IN PATIENTS TREATED WITH CORTICOSTEROIDS FOR SEVERE COVID-19 PNEUMONIA: A RETROSPECTIVE OBSERVATIONAL COHORT STUDY

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INTRO: Current evidence is still lacking in use of baricitinib among COVID-19 patients that require low flow oxygen and have systemic inflammation. Therefore, we are keen to evaluate the efficacy of baricitinib therapy among this group of patients, in preventing progression into high flow oxygen devices, mechanical ventilation and reducing mortality. METHODS: All hospitalised COVID-19 patients that required low flow oxygen with evidence of elevated inflammatory markers (either CRP > 50mg/L or ferritin > 500 mcg/L) were enrolled. It compared those that received standard of care (SOC) between April 2021 and May 2021, with another cohort of patients that received baricitinib and SOC between August 2021 and September 2021. Statistics were propensity score matched for age, gender, comorbidities, oxygen level, CRP and SPO2/FiO2 ratio. FINDINGS: Five-hundred fifty patients were included in the standard of care arm (SOC, n=275) and baricitinib-treated arm (BCT-SOC, n=275). Subjects in baricitinib-treated arm received a median 7 days of baricitinib. There was a significant reduction in the need for mechanical ventilation with baricitinib- treated arm compared with SOC arm (11.3% [31/275] BCT-SOC, 18.9% [52/275] SOC; HR 0.55, 95%CI 0.35-0.86; p=0.009). We found more patients in baricitinib- treated arm progressed into non-invasive ventilation or other high flow oxygen devices (26.9% [74/275] BCT-SOC, 19.6% [54/275] SOC; HR 1.45, 95%CI 1.02- 1.46; p=0.037). There was no significant difference in 28-day mortality among 2 groups (8% [22/275] BCT-SOC, 6.9% [19/275] SOC, HR 1.16, 95%CI 0.63-2.1; p=0.646). DISCUSSION: In our cohort of COVID-19 patients that require low flow oxygen and have systemic inflammation, a short course of baricitinib used in conjunction with SOC reduced needs of mechanical ventilation. This could help relieve our intensive care burden during COVID-19 crisis. CONCLUSION: Despite showing reduced needs of invasive ventilation, it did not translate into mortality benefits. Thus, prospective randomized study is required to determine the optimal timing for initiation of baricitinib.

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