Impact of high dose of baricitinib in severe COVID-19 pneumonia: a prospective cohort study in Bangladesh

Abstract

Purpose Hyperinflammation in severe COVID-19 infection increases the risk of respiratory failure and one of the cogent reasons of mortality associated with COVID-19. Baricitinib, a janus kinases inhibitor, can potentially suppress inflammatory cascades in severe COVID-19 pneumonia. Methods The objective of this study was to compare the clinical outcomes of high dose of baricitinib with its usual dose in patients with severe COVID-19 pneumonia. This prospective cohort study was conducted on 238 adult patients with severe COVID-19 pneumonia. Eight milligram and 4 mg of baricitinib was given orally to 122 patients in the high dose (HD) group and 116 patients the usual dose (UD) group, respectively daily for 14 days, and clinical outcomes were compared among the groups. Results Blood oxygen saturation level was stabilized (≥94% on room air) earlier in the HD group compared to the UD group [5 (IQR: 4–5)/8 (IQR: 6–9), P < 0.05]. Patients in the HD group required intensive care unit (ICU) and intubation supports more in the UD group than that in patients of the HD group [17.2%/9%, P < 0.05; 11.2%/4.1%, P > 0.05; N = 116/122, respectively]. The 30-day mortality and 60-day rehospitalization rate were higher in the UD group than the HD group [6%/3.3%, P < 0.01; 11.9%/7.6%, P > 0.05; N = 116/122, respectively]. Conclusion The daily high dose of baricitinib in severe COVID-19 results in early stabilization of the respiratory functions, declined requirements of critical care supports, reduced rehospitalization with mortality rate compared to its daily usual dose.

Efficacy and safety of baricitinib for the treatment of hospitalised adults with COVID-19 (COV-BARRIER): a randomised, double-blind, parallel-group, placebo-controlled phase 3 trial

“…Future research on baricitinib in patients with COVID-19 should include assessment of the effect of baricitinib at higher doses or with a loading dose to prevent progression events. 33 …”

Hospital readmissions and post-discharge all-cause mortality in COVID-19 recovered patients; A systematic review and meta-analysis

“…In the manual search of gray literature and preprints, 18 potentially related papers were included. After reviewing the titles and abstracts of the articles, 157 peer-reviewed papers or preprinted manuscripts were reviewed and a total of 91 articles were entered into the present meta-analysis [ 8 , [14] , [15] , [16] , [17] , [18] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] ,…”

“…Increasing numbers of recovered COVID-19 patients and their follow-up has shown that that the post-discharge mortality of COVID-19 patients occurs one year after discharge from the index hospitalization. Prevalence of post-discharge mortality of COVID-19 patients was reported between 0% [ 17 ] to 37% [ 18 ]. However, most studies are single-site researches, and there exists no comprehensive data on post-discharge mortality of recovered COVID-19 patients.…”

Pharmacology and Adverse Events of Emergency-Use Authorized Medication in Moderate to Severe COVID-19

“…However, the potential benefits of treatment with baricitinib against potential risks should be weighed in patients with neutropenia, lymphopenia or other active infections, such as tuberculosis [ 11 ] and hepatitis B virus infection [ 61 , 62 ]. A higher dose of baricitinib might result in early stabilization of respiratory functions, but it could increase the risk of thromboembolism [ 63 ]. Baricitinib should be promptly discontinued if a serious hypersensitivity reaction occurs [ 57 ].…”