Baricitinib versus tocilizumab in critically ill COVID‐19 patients: A retrospective cohort study

Abstract

BackgroundTocilizumab and baricitinib improve outcomes in severely ill patients with coronavirus disease 2019 (COVID‐19), however, comparative analyses of clinical outcomes related to these agents is lacking. A tocilizumab national shortage shifted treatment to baricitinib in critically ill patients, allowing for an outcome comparison in a similar population. The purpose of this study is to compare clinical outcomes in critically ill COVID‐19 patients who received tocilizumab and those who received baricitinib.MethodsThis retrospective, multicenter cohort study of adult patients with severe COVID‐19 compared the use of tocilizumab, before its shortage, to baricitinib use during the shortage. Both drugs were formulary restricted at the study sites with identical patient criteria for use. The primary outcome was World Health Organization Clinical Progression Scale (WHO‐CPS) score at day 14. Secondary outcomes included WHO‐CPS score at day 7. Generalized estimating equation models were utilized, accounting for clustering by hospital and known confounders, to estimate the proportional odds of the ordinal WHO‐CPS score at day 14.ResultsIn total, 507 patients were included; 217 received tocilizumab and 290 received baricitinib. Over 96% of patients required ICU admission and 98% received concomitant dexamethasone. Tocilizumab recipients had higher (worse) baseline WHO‐CPS scores. After adjustment, tocilizumab use was associated with higher odds of a worse day 14 WHO‐CPS score compared with baricitinib (adjusted odds ratio [OR] 1.65 [95% confidence interval (CI) 1.10‐2.48]). Similarly, after adjustment, tocilizumab use was associated with higher odds of a worse day 7 WHO‐CPS score (adjusted OR 1.65 [95% CI 1.22‐2.24]).ConclusionsBaricitinib use was associated with better WHO‐CPS scores at day 14 and day 7 compared with tocilizumab in a cohort of critically ill patients with COVID‐19. The odds of having a one unit increase in WHO‐CPS score at day 14 was 71% higher with tocilizumab than baricitinib. No difference in mortality or adverse effects was noted.