Study compares baricitinib to dexamethasone in COVID-19

For hospitalized patients with COVID-19 who require supplemental oxygen, baricitinib plus remdesivir and dexamethasone plus remdesivir result in similar survival without mechanical ventilation through day 29, but adverse events are more common with dexamethasone, according to a published online May 23 study The Lancet Respiratory Medicine.

Cameron R. Wolfe, MBBS, of Duke University in Durham, North Carolina, and colleagues conducted a randomized trial of 1,010 hospitalized adults with COVID-19 receiving supplemental oxygen through low-flow, high-flow, or noninvasive mechanical ventilation modalities required. Participants were randomized to receive either baricitinib plus remdesivir plus placebo (516 patients) or dexamethasone plus remdesivir plus placebo (494 patients).

The researchers found that survival without mechanical ventilation through Day 29 was similar between the groups (87.0 percent in the baricitinib group and 87.6 percent in the dexamethasone group). The odds ratio for improved status in the dexamethasone group versus the baricitinib group was 1.01 (95 percent confidence interval, 0.80 to 1.27). At least one adverse event occurred in 30 and 37 percent of patients in the baricitinib and dexamethasone groups, respectively. Overall, 4 and 10 percent of patients in the baricitinib and dexamethasone groups, respectively, had at least one treatment-emergent adverse event.

“Dexamethasone was associated with significantly more adverse events, treatment-emergent adverse events, and serious or life-threatening adverse events,” a co-author said in a statement. “A more individual choice of immunomodulation now appears possible, taking into account the side effect profile, ease of administration, costs and comorbidities of the patient.”

Baricitinib does not slow the progression of COVID-19 in hospitalized adults

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