Comparative evaluation of baricitinib and tocilizumab in patients with COVID-19

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.