ABSTRACT
Intro Current evidence is still lacking in use of baricitinib among COVID-19 patients that require low flow oxygen and have systemic inflammation. Therefore, we are keen to evaluate the efficacy of baricitinib therapy among this group of patients, in preventing progression into high flow oxygen devices, mechanical ventilation and reducing mortality. Methods All hospitalised COVID-19 patients that required low flow oxygen with evidence of elevated inflammatory markers (either CRP > 50mg/L or ferritin > 500 mcg/L) were enrolled. It compared those that received standard of care (SOC) between April 2021 and May 2021, with another cohort of patients that received baricitinib and SOC between August 2021 and September 2021. Statistics were propensity score matched for age, gender, comorbidities, oxygen level, CRP and SPO2/FiO2 ratio. Findings Five-hundred fifty patients were included in the standard of care arm (SOC, n=275) and baricitinib-treated arm (BCT-SOC, n=275). Subjects in baricitinib-treated arm received a median 7 days of baricitinib. There was a significant reduction in the need for mechanical ventilation with baricitinib- treated arm compared with SOC arm (11.3% [31/275] BCT-SOC, 18.9% [52/275] SOC;HR 0.55, 95%CI 0.35-0.86;p=0.009). We found more patients in baricitinib- treated arm progressed into non-invasive ventilation or other high flow oxygen devices (26.9% [74/275] BCT-SOC, 19.6% [54/275] SOC;HR 1.45, 95%CI 1.02- 1.46;p=0.037). There was no significant difference in 28-day mortality among 2 groups (8% [22/275] BCT-SOC, 6.9% [19/275] SOC, HR 1.16, 95%CI 0.63-2.1;p=0.646). Discussion In our cohort of COVID-19 patients that require low flow oxygen and have systemic inflammation, a short course of baricitinib used in conjunction with SOC reduced needs of mechanical ventilation. This could help relieve our intensive care burden during COVID-19 crisis. Conclusion Despite showing reduced needs of invasive ventilation, it did not translate into mortality benefits. Thus, prospective randomized study is required to determine the optimal timing for initiation of baricitinib.
ABSTRACT
Coronavirus disease 2019 (COVID-19) has spread fast and extensively around the world, with significant mortality and morbidity. As this is a respiratory infection, chest radiography and computed tomography (CT) are important imaging techniques in the work-up of this disease. Given its highly infectious nature, cross-infection within the healthcare setting and radiology departments needs to be addressed actively and prevented. We describe the response of radiology departments in Singapore to this pandemic, in terms of diagnosis, re-configuration of the department, re-organisation and segregation of staff, infection control, managerial, and leadership issues.