ABSTRACT
Introduction: The Food and Drug Administration authorized baricitinib and tocilizumab for emergency use for the treatment of suspected or confirmed COVID-19 in high-risk hospitalized patients. To balance the scarcity of drug with broad emergency use authorization criteria, our facility imposed more stringent criteria. While both drugs have been shown to reduce 28-day mortality in COVID-19, it is unclear if one drug has a place in therapy different from the other. Research Question or Hypothesis: Is there a significant difference in 28-day mortality between patients treated with baricitinib compared to tocilizumab? Study Design: Single-center, retrospective cohort Methods: The electronic medical record was queried for all consecutive patients who received either baricitinib or tocilizumab in a 6-month period. The primary outcome was 28-day mortality in COVID-19 patients who received either drug. Patients had to receive concomitant corticosteroids and supplemental oxygenation not more than 24 hours before therapy initiation. Secondary outcomes included in-hospital mortality, incidence of secondary bacterial infections (SBI), and other relevant comparisons. Fisher's Exact Test was used to compare categorical data;independent samples t-test and Wilcoxon Rank Sum were used to compare normally and non-normally distributed continuous data, respectively. Results: Fifty patients were included: 8 (16%) received baricitinib and 42 (84%) received tocilizumab. Baseline characteristics were similar between groups including APACHE-II score (21.02±16.54). 28-day mortality was higher for tocilizumab (50% vs. 12.5%, p=0.064) but did not reach significance. In-hospital mortality was significantly higher for tocilizumab (57.1% vs. 12.5%, p=0.049). There was no significant difference in the incidence of SBI or vasopressor requirements between the groups. Conclusion: Although tocilizumab resulted in significantly higher inhospital mortality, these patients could have been unable to take oral agents, like baricitinib, and have had further progression of COVID- 19. Until larger studies are conducted, the choice of one agent over another will likely be based on situation-specific factors.
ABSTRACT
Background. Casirivimab/imdevimab is a monoclonal antibody (mAb) cocktail with emergency use authorization for mild-to-moderate coronavirus disease 2019 (Covid-19) in patients at high risk for severe disease progression and/or hospitalization. Little is known about the importance of early administration of this product. The objective of this study was to determine if early administration (within 3 days of symptom onset) of casirivimab/imdevimab is associated with better outcomes. Methods. Single-center, retrospective cohort study including all consecutive patients who received casirivimab/imdevimab at our institution through May 2021. The primary outcome was 30-day post-infusion hospital admission rate in patients who received mAb ≥ 3 days (later) or < 3 days (early) in relation to patient reported symptom onset. Secondary outcomes included any hospital revisit within 30-days. Adverse events were also captured. Chi-square and independent samples t-test were used to compare categorical and continuous data, respectively. Multivariable logistic regression was used to adjust for confounders. Results. 270 patients met the inclusion criteria and were included in the analysis. There were 80 patients with early administration and 190 with later administration. Baseline characteristics for both groups were similar. Mean age was approximately 64 years and BMI 31 mg/m2. Table 1 provides a summary of patient characteristics. Late and early administration of casirivimab/imdevimab were similar in terms of hospital admission for any therapy related failure within 30 days of mAb administration after adjusting for age and Charlson comorbidity index (3.7% vs. 7.5%;adjusted odds ratio 0.69, 95% confidence interval, 0.20 -2.39;p=0.561). Similarly, there were no significant differences in any hospital revisit. Conclusion. We did not find any difference in outcomes between early and late administration of casirivimab/imdevimab.