Additional baricitinib loading dose improves clinical outcome in COVID-19

Abstract

Pneumonia associated with coronavirus disease 2019 (COVID-19) has been accounted for high mortality rate in severe COVID-19 worldwide, and additional serious scarcity of standard and effective anti-inflammatory drug in COVID-19 pneumonia management is a big challenge. Baricitinib, a Janus kinase (JAK) inhibitor, is a promising drug in COVID-19 pneumonia. This study aims to compare the clinical outcome of moderate-to-severe COVID-19 pneumonia treated with baricitinib with or without a loading dose. This prospective case-control study enrolled 37 adult patients where 17 patients (control) received baricitinib at 4 mg oral daily dose and 20 patients (case) received an additional single 8 mg oral loading dose. The median day to gain blood oxygen saturation level ≥95% (in room air) and return in normal breathing function were lower in case group than the control group. The requirement of intensive care unit and mechanical ventilation support was higher in the control group than in the case group [29.4% (N = 17)/10% (N = 20), P < 0.05; 11.8% (N = 17)/5% (N = 20), P > 0.05), respectively]. Thus, an additional loading dose of baricitinib revealed better clinical outcome of patients with COVID-19 pneumonia.

Clinical efficacy and safety of Janus kinase inhibitors for COVID-19: A systematic review and meta-analysis of randomized controlled trials

“…Janus kinase (JAK) inhibitors can downregulate the JAK/signal transducer and activator of transcription protein signaling pathways and decrease cytokine concentrations, and therefore they have been proposed as a potential therapies to mitigate the immune response and prevent a hyperinflammatory state, which may further improve clinical outcomes of hospitalized COVID-19 patients [7] , [8] , [9] , [10] . The clinical uses of JAK inhibitors, including ruxolitinib, baricitinib, and tofacitinib for COVID-19 patients have been reported in many observational studies [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , in which adding JAK inhibitors could help resolve a hyperinflammatory state, improve respiratory function, reduce mortality, and increase survival discharge for patients with SARS-CoV-2 infections. Although two meta-analyses [19] , [20] assessed the efficacy of JAK inhibitors on the clinical outcomes of COVID-19 patients, cohort studies or non-randomized controlled trials (RCTs) comprised more than half of the included studies, and only two RCTs [21] , [22] were included in these two meta-analyses.…”

One-year review of COVID-19 in the Arab world

“…Since the beginning of the COVID-19 crisis, the total death cases in the Arab countries was highest in November, followed by a fluctuation between a slight decline and elevation. This might be attributed to several factors such as: (i) the improvement of medical management and the coordinated efforts of the health system, (ii) medical caregivers became more familiar in dealing with the crisis and in alleviating patients' suffering, (iii) the community awareness and education of COVID-19 prompted immediate efforts in seeking of medical treatment to decrease disease severity, (iv) the use of drugs such as Remdesivir, Tocilizumab, and Baricitinib increased the quality of medical care [26][27][28], and (v) increased number of tests and testing methods contributed to the reduction of the overall death rate as high numbers of tests enabled healthcare providers to quickly detect and assess more cases with mild symptoms or even asymptomatic cases. Apart from the medical care management system, governmental restriction strategies such as closure of schools and businesses, bans on gatherings, quarantine for travelers, travel restrictions, maintaining physical distance and including orders to stay at home limited viral transmission and led to a drop in positive cases and, thus, a decrease in the deaths [29].…”

Janus Kinase Inhibitors and Coronavirus Disease (COVID)-19: Rationale, Clinical Evidence and Safety Issues

“…Overall, 11 studies (one randomized controlled trial, eight observational studies, one case series, and one case report) investigating the efficacy and safety of baricitinib in moderate-severe COVID-19 pneumonia were retrieved [ 14 , 17 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. The main features of the included studies are shown in Table 2 .…”