The rheumatoid arthritis drug baricitinib [pronounced BAR-i-SIGH-ti-nib] was shown to reduce mortality in hospitalized COVID-19 patients, according to a randomized, controlled trial published in The Lancet Respiratory Medicine.
Baricitinib, an inhibitor of (Janus kinase, JAK) JAK1 and JAK2, has been appraised in artificial intelligence early on in the pandemic in February 2020 and mechanistic laboratory studies and human clinical trials, with multiple mechanisms of action identified, including anticytokine effects and inhibition of host cell viral propagation.
Potential side-effects of the drug, such as secondary infections and venous thrombosis, are related to changes in the inflammatory and coagulation cascades. However, these side-effects have been rare in patients with rheumatoid arthritis, the approved indication for baricitinib.
Baricitinib is under emergency use authorization to treat severe COVID-19 by the US Food and Drug Administration.
The study, called COV-BARRIER, consisted of 1,525 hospitalized COVID-19 patients (median age, 57.6 years) from 12 countries who received either baricitinib daily for 14 days or placebo in addition to standard care, which could have included remdesivir or dexamethasone.
Those in the intervention arm had lower mortality rates at 28 days (8% vs 13%)—which indicates that for every 20 patients treated 1 death is prevented—as well as at 60 days (10% vs 15%). The treatment did not stop disease progression, however: 27.8% of baricitinib and 30.5% of placebo recipients had outcomes requiring ventilation or high-flow oxygen needs, or they died.
Overall, baricitinib was connected with hazard ratios of 0.57 for 28-day all-cause mortality (43% lower death rate) and 0.62 for 60-day all-cause mortality (38% lower). Serious adverse events, serious infections, and venous thromboembolic events were similar between both groups.
Importantly, the COV-BARRIER study showed that the survival benefits provided by baricitinib were independent of the presence or absence of concomitant use of steroids (mostly dexamethasone)—i.e., an absence of treatment interaction.
Although the drug definitively reduces the chance of death from COVID-19, the drug didn’t seem to slow down the progression of the disease.
Therefore, as far as COVID is concerned, prevention is indeed much better than cure.
***
Dr. Melvin Sanicas (@Vaccinologist) is a physician-scientist specializing in vaccines, infectious diseases, and global health.