Background. Management of COVID--19 patients during surges have been a challenge as hospitals have to deal with staff, room, and medication shortages. Among these medications is tocilizumab which is given to patients with severe/critical conditions. In Ospital ng Makati, patients are given baricitinib as alternative immunomodulator to prevent possible cytokine storm during tocilizumab shortages. The current recommendation for baricitinib is to give it in addition to dexamethasone and remdesivir for hospitalized COVID-19 patients requiring low to high-flow oxygen, and non-invasive ventilation. However, there is not enough evidence to recommend it as an alternative to tocilizumab in COVID--19 patients. This study aims to find out the real-world efficacy of baricitinib in addition to standard of care among admitted patients with severe COVID-19 pneumonia admitted in Ospital ng Makati.

Methods. This is a retrospective, case control study that reviewed records of adult patients admitted at Ospital ng Makati from December 2020 to May 2021 due to severe COVID-19. Patients who were given standard of care was compared to those who were given baricitinib by measuring the duration of clinical improvement, in-hospital all-cause mortality, number of hospital stay, and progression to acute respiratory distress syndrome (ARDS) and need for mechanical ventilator.

Results. The use of baricitinib led to a faster improvement time (10 vs 12 days) however did not reach level of significance (p=0.069). There was also no significant difference in the mortality, number of hospital days, and progression to ARDS between the two groups.

Conclusion. There is not enough evidence to recommend baricitinib as an alternative to tocilizumab in patients with severe COVID--19 infection.

Keywords: COVID-19, baricitinib, tocilizumab, standard of care

1. Dexamethasone in Hospitalized Patients with COVID--19. New England Journal of Medicine [Internet]. 2020 Jul 17;384(8):693–704. Available from: https://doi.org/10.1056/NEJMoa2021436
2. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the Treatment of COVID--19 — Final Report. New England Journal of Medicine [Internet]. 2020 May 22;383(19):1813–26. Available from: https://doi.org/10.1056/NEJMoa2007764
3. Repurposed Antiviral Drugs for COVID--19 — Interim WHO Solidarity Trial Results. New England Journal of Medicine [Internet]. 2020 Dec 2;384(6):497–511. Available from: https://doi.org/10.1056/NEJMoa2023184
4. Organization WH. COVID-19 clinical management: living guidance, 25 January 2021 [Internet]. Geneva: World Health Organization; 2021. Available from: https://apps.who.int/iris/handle/10665/338882
5. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National Institutes of Health. [Internet]. [cited 2023 Jan 23]. Available from: https://files.covid19treatmentguidelines.nih.gov/guidelines/archive/covid19treatmentguidelines-12-28-2022.pdf
6. Abani O, Abbas A, Abbas F, Abbas M, Abbasi S, Abbass H, et al. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. The Lancet [Internet]. 2021 May 1;397(10285):1637–45. Available from: https://doi.org/10.1016/S0140-6736(21)00676-0
7. IDSA Guidelines on the Treatment and Management of Patients with COVID-19 [Internet]. [cited 2023 Jan 23]. Available from: https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/
8. Kalil AC, Patterson TF, Mehta AK, Tomashek KM, Wolfe CR, Ghazaryan V, et al. Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19. New England Journal of Medicine [Internet]. 2020 Dec 11;384(9):795–807. Available from: https://doi.org/10.1056/NEJMoa2031994
9. INTERIM GUIDANCE ON THE CLINICAL MANAGEMENT OF ADULT PATIENTS WITH SUSPECTED OR CONFIRMED COVID-19 INFECTION. 2020;
10. Organization WH. COVID-19 clinical management: living guidance, 25 January 2021 [Internet]. Geneva: World Health Organization; 2021. Available from: https://apps.who.int/iris/handle/10665/338882
11. Marconi VC, Ramanan A V, de Bono S, Kartman CE, Krishnan V, Liao R, et al. 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. Lancet Respir Med [Internet]. 2021 Dec 1;9(12):1407–18. Available from: https://doi.org/10.1016/S2213-2600(21)00331-3
12. Garibaldi BT, Wang K, Robinson ML, Zeger SL, Bandeen-Roche K, Wang MC, et al. Comparison of Time to Clinical Improvement With vs Without Remdesivir Treatment in Hospitalized Patients With COVID-19. JAMA Netw Open [Internet]. 2021 Mar 24 [cited 2023 Jan 21];4(3). Available from: https://pubmed.ncbi.nlm.nih.gov/33760094/
13. Dodd LE, Follmann D, Wang J, Koenig F, Korn LL, Schoergenhofer C, et al. Endpoints for randomized controlled clinical trials for COVID-19 treatments. Clinical Trials [Internet]. 2020 Jul 16;17(5):472–82. Available from: https://doi.org/10.1177/1740774520939938
14. IDSA Guidelines on the Treatment and Management of Patients with COVID-19 [Internet]. [cited 2023 Jan 21]. Available from: https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/