Baricitinib improves respiratory function in patients treated with corticosteroids for SARS-CoV-2 pneumonia: an observational cohort study.

OBJECTIVES: The Janus kinase (JAK) inhibitor baricitinib may block viral entry into pneumocytes and prevent cytokine storm in patients with SARS-CoV-2 pneumonia. We aimed to assess whether baricitinib improved pulmonary function in patients treated with high-dose corticosteroids for moderate to severe SARS-CoV-2 pneumonia. METHODS: This observational study enrolled patients with moderate to severe SARS-CoV-2 pneumonia [arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (FiO2) <200 mmHg] who received lopinavir/ritonavir and HCQ plus either corticosteroids (CS group, n = 50) or corticosteroids and baricitinib (BCT-CS group, n = 62). The primary end point was the change in oxygen saturation as measured by pulse oximetry (SpO2)/FiO2 from hospitalization to discharge. Secondary end points included the proportion of patients requiring supplemental oxygen at discharge and 1 month later. Statistics were adjusted by the inverse propensity score weighting (IPSW). RESULTS: A greater improvement in SpO2/FiO2 from hospitalization to discharge was observed in the BCT-CS vs CS group (mean differences adjusted for IPSW, 49; 95% CI: 22, 77; P < 0.001). A higher proportion of patients required supplemental oxygen both at discharge (62.0% vs 25.8%; reduction of the risk by 82%, OR adjusted for IPSW, 0.18; 95% CI: 0.08, 0.43; P < 0.001) and 1 month later (28.0% vs 12.9%, reduction of the risk by 69%, OR adjusted for IPSW, 0.31; 95% CI: 0.11, 0.86; P = 0.024) in the CS vs BCT-CS group. CONCLUSIONS: . In patients with moderate to severe SARS-CoV-2 pneumonia a combination of baricitinib with corticosteroids was associated with greater improvement in pulmonary function when compared with corticosteroids alone. TRIAL REGISTRATION: European Network of Centres for Pharmacoepidemiology and Pharmacovigilance, ENCEPP (EUPAS34966, http://www.encepp.eu/encepp/viewResource.htm? id = 34967).

Inhaled nitric oxide in adult patients with acute respiratory distress syndrome / Óxido nítrico inhalado en pacientes adultos con síndrome de distrés respiratorio agudo

In some patients, acute respiratory distress syndrome (ARDS) leads to life-threatening refractory hypoxemia developing. Physicians may consider hypoxemic rescue therapies in an attempt to improve oxygenation in these patients while on conventional mechanical ventilation support. Use of inhaled nitric oxide (iNO) in ARDS is one of the most widely-studied pharmacological interventions over the past two decades. Its efficacy was examined in several randomized clinical trials and has undergone meta-analyses. Although iNO treatment was associated with improved oxygenation, researchers unfortunately never demonstrated a concomitant decrease in mortality or any improved outcome. Hence the current evidence suggests that iNO should not be routinely used in patients with ARDS however may be considered as adjunct therapy to tentatively improve oxygenation while other therapies are being considered in patients with severely hypoxemic ARDS. This review focuses on the therapeutic use of iNO in adult ARDS patients. We set out some recommendations for its use as rescue therapy against refractory hypoxemia (AU)

En algunos pacientes, el síndrome de distrés respiratorio agudo (SDRA) provoca el desarrollo de una hipoxemia refractaria que compromete la vida. En este contexto pueden considerarse terapias de rescate en un intento de mejorar la oxigenación mientras los pacientes permanecen en ventilación mecánica. El uso de óxido nítrico inhalado (NOi) en el SDRA ha sido una de las terapias farmacológicas más estudiadas en las últimas dos décadas. Diversos ensayos clínicos y metaanálisis han evaluado su eficacia, y aunque se ha demostrado un aumento en la oxigenación, no se ha podido demostrar un descenso en la mortalidad o una mejora en el pronóstico. La evidencia actual sugiere que aunque el NOi no debe usarse de forma rutinaria en pacientes con SDRA, puede considerarse su uso para mejorar la oxigenación en pacientes severamente hipoxémicos. Esta revisión examina la aplicación terapéutica del NOi en pacientes adultos con SDRA. Se propone un esquema con diversas recomendaciones para su uso como terapia de rescate frente a la hipoxemia refractaria (AU)

Inhaled nitric oxide in adult patients with acute respiratory distress syndrome.

In some patients, acute respiratory distress syndrome (ARDS) leads to life-threatening refractory hypoxemia developing. Physicians may consider hypoxemic rescue therapies in an attempt to improve oxygenation in these patients while on conventional mechanical ventilation support. Use of inhaled nitric oxide (iNO) in ARDS is one of the most widely-studied pharmacological interventions over the past two decades. Its efficacy was examined in several randomized clinical trials and has undergone meta-analyses. Although iNO treatment was associated with improved oxygenation, researchers unfortunately never demonstrated a concomitant decrease in mortality or any improved outcome. Hence the current evidence suggests that iNO should not be routinely used in patients with ARDS however may be considered as adjunct therapy to tentatively improve oxygenation while other therapies are being considered in patients with severely hypoxemic ARDS.This review focuses on the therapeutic use of iNO in adult ARDS patients. We set out some recommendations for its use as rescue therapy against refractory hypoxemia.

En algunos pacientes, el síndrome de distrés respiratorio agudo (SDRA) provoca el desarrollo de una hipoxemia refractaria que compromete la vida. En este contexto pueden considerarse terapias de rescate en un intento de mejorar la oxigenación mientras los pacientes permanecen en ventilación mecánica. El uso de óxido nítrico inhalado (NOi) en el SDRA ha sido una de las terapias farmacológicas más estudiadas en las últimas dos décadas. Diversos ensayos clínicos y metaanálisis han evaluado su eficacia, y aunque se ha demostrado un aumento en la oxigenación, no se ha podido demostrar un descenso en la mortalidad o una mejora en el pronóstico. La evidencia actual sugiere que aunque el NOi no debe usarse de forma rutinaria en pacientes con SDRA, puede considerarse su uso para mejorar la oxigenación en pacientes severamente hipoxémicos.Esta revisión examina la aplicación terapéutica del NOi en pacientes adultos con SDRA. Se propone un esquema con diversas recomendaciones para su uso como terapia de rescate frente a la hipoxemia refractaria.