ABSTRACT
INTRODUCTION: The dysregulated inflammatory response to SARS-CoV-2 plays a crucial role in the pathogenesis of Coronavirus Disease 2019 (COVID-19). The National Institutes of Health (NIH) guidelines recommend adding a second immunomodulatory agent, tocilizumab (TCZ) or baricitinib (BARI), to dexamethasone in patients with rapidly increasing oxygen requirements and systemic inflammation. As of July 2022, these guidelines do not recommend one agent over the other. This study aims to compare the progression rates to mechanical ventilation and in-hospital mortality for TCZ vs. BARI in patients with moderate to severe COVID-19. METHOD(S): This was a single-center, retrospective, cohort study of patients treated with TCZ or BARI for COVID-19 between August 24, 2021, and December 31, 2021. The primary endpoint was a composite outcome of progression to mechanical ventilation or in-hospital mortality. Secondary endpoints included components of the composite outcome, progression to a higher level of care, duration of mechanical ventilation, hospital length of stay (LOS), and intensive care unit (ICU) LOS. Safety endpoints included the incidence of infection and thrombosis. RESULT(S): One-hundred-seventy-six patients were included, of which 61 (34.7%) received TCZ and 115 (65.3%) received BARI. The primary outcome was not significant between groups (52.5% TCZ vs. 44.3% BARI, p=0.305). There were no statistically significant differences noted between TCZ and BARI in regards to progression to mechanical ventilation (36.1% vs 28.7%, p=0.315), inhospital mortality (50.8% vs 41.7%, p=0.249), progression to higher level of care (18% vs 17.4%, p=0.926), duration of mechanical ventilation (median 9 days vs 6 days, p=0.311), hospital LOS (median 8 days vs 14 days, p=0.193), or ICU LOS (median 7 days vs 8 days, p=0.964). For safety outcomes, there was no difference in the infection rate (36.1% vs. 26.1%, p=0.167), but the rate of thrombosis was higher in the TCZ group (11.5% vs. 3.5%, p=0.042). CONCLUSION(S): There was no significant difference in the composite outcome of progression to mechanical ventilation or in-hospital mortality in patients who received TCZ of BARI for the treatment of COVID-19. However, this primary outcome occurred more frequently in the TCZ group, and a larger study may be able to detect this difference.