Abstract
Objectives: The Janus kinase (JAK) inhibitor baricitinib may block viral entry into pneumocytes and prevent cytokine storm in patients with SARS-CoV-2 pneumonia. We aimed to assess whether baricitinib improved pulmonary function in patients treated with high-dose corticosteroids for moderate to severe SARS-CoV-2 pneumonia.
Methods: This observational study enrolled patients with moderate to severe SARS-CoV-2 pneumonia [arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (FiO2) <200 mmHg] who received lopinavir/ritonavir and HCQ plus either corticosteroids (CS group, n = 50) or corticosteroids and baricitinib (BCT-CS group, n = 62). The primary end point was the change in oxygen saturation as measured by pulse oximetry (SpO2)/FiO2 from hospitalization to discharge. Secondary end points included the proportion of patients requiring supplemental oxygen at discharge and 1 month later. Statistics were adjusted by the inverse propensity score weighting (IPSW).
Results: A greater improvement in SpO2/FiO2 from hospitalization to discharge was observed in the BCT-CS vs CS group (mean differences adjusted for IPSW, 49; 95% CI: 22, 77; P < 0.001). A higher proportion of patients required supplemental oxygen both at discharge (62.0% vs 25.8%; reduction of the risk by 82%, OR adjusted for IPSW, 0.18; 95% CI: 0.08, 0.43; P < 0.001) and 1 month later (28.0% vs 12.9%, reduction of the risk by 69%, OR adjusted for IPSW, 0.31; 95% CI: 0.11, 0.86; P = 0.024) in the CS vs BCT-CS group.
Conclusions: . In patients with moderate to severe SARS-CoV-2 pneumonia a combination of baricitinib with corticosteroids was associated with greater improvement in pulmonary function when compared with corticosteroids alone.
Trial registration: European Network of Centres for Pharmacoepidemiology and Pharmacovigilance, ENCEPP (EUPAS34966, http://www.encepp.eu/encepp/viewResource.htm? id = 34967).
Keywords: COVID-19; SARS-CoV-2; baricitinib; corticosteroids.
【저자키워드】 COVID-19, SARS-CoV-2, Baricitinib, Corticosteroids, 【초록키워드】 Corticosteroid, Baricitinib, Cytokine storm, Corticosteroids, Lopinavir/ritonavir, Hospitalization, Pneumonia, pulse oximetry, Lopinavir, Ritonavir, risk, oxygen, cytokine, viral entry, discharge, observational study, pharmacoepidemiology, pharmacovigilance, oxygen saturation, Pulmonary function, Viral, Statistics, Patient, network, HCQ, SARS-CoV-2 pneumonia, inhibitor, Jak, moderate, Combination, Pneumocytes, Janus kinase, moderate to severe, partial pressure, oxygen partial pressure, reduction, supplemental oxygen, High-dose, FiO2, PaO2, SpO2, arterial oxygen partial pressure, end point, primary end point, SpO2/FiO2, block viral entry, Weighting, European, Prevent, secondary, severe SARS-CoV-2, greater, enrolled, proportion, required, adjusted, pneumocyte, patients treated, patients with moderate, patients with SARS-CoV-2, requiring supplemental oxygen, 【제목키워드】 Corticosteroid, Baricitinib, Corticosteroids, Respiratory function, Observational cohort study, IMPROVE, patients treated,