TY - JOUR
T1 - Comparative Effectiveness of Baricitinib Versus Tocilizumab in Hospitalized Patients With COVID-19
T2 - A Retrospective Cohort Study of the National Covid Collaborative
AU - National COVID Cohort Collaborative (N3C) Consortium
AU - Patanwala, Asad E.
AU - Xiao, Xuya
AU - Hills, Thomas E.
AU - Higgins, Alisa M.
AU - McArthur, Colin J.
AU - Caleb Alexander, G.
AU - Mehta, Hemalkumar B.
AU - Wilcox, Adam B.
AU - Lee, Adam M.
AU - Graves, Alexis
AU - Anzalone, Alfred
AU - Manna, Amin
AU - Saha, Amit
AU - Olex, Amy
AU - Zhou, Andrea
AU - Williams, Andrew E.
AU - Southerland, Andrew
AU - Girvin, Andrew T.
AU - Walden, Anita
AU - Sharathkumar, Anjali A.
AU - Amor, Benjamin
AU - Bates, Benjamin
AU - Hendricks, Brian
AU - Patel, Brijesh
AU - Alexander, Caleb
AU - Bramante, Carolyn
AU - Ward-Caviness, Cavin
AU - Madlock-Brown, Charisse
AU - Suver, Christine
AU - Chute, Christopher
AU - Dillon, Christopher
AU - Wu, Chunlei
AU - Schmitt, Clare
AU - Takemoto, Cliff
AU - Housman, Dan
AU - Gabriel, Davera
AU - Eichmann, David A.
AU - Mazzotti, Diego
AU - Brown, Don
AU - Boudreau, Eilis
AU - Hill, Elaine
AU - Zampino, Elizabeth
AU - Carlson Marti, Emily
AU - Pfaff, Emily R.
AU - French, Evan
AU - Koraishy, Farrukh M.
AU - Mariona, Federico
AU - Prior, Fred
AU - Sokos, George
AU - Martin, Greg
N1 - Publisher Copyright:
Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2025/1/1
Y1 - 2025/1/1
N2 - OBJECTIVES: COVID-19 treatment guidelines recommend baricitinib or tocilizumab for the management of hospitalized patients with COVID-19. We compared the effectiveness of baricitinib vs. tocilizumab on mortality and clinical outcomes among hospitalized patients with COVID-19. DESIGN: Multicenter, retrospective, propensity-weighted cohort study using a target trial emulation approach. SETTING: The National COVID Cohort Collaborative (N3C), which is the largest electronic health records data on COVID-19 in the United States. The setting included 75 hospitals. PATIENTS: Adults who were hospitalized for COVID-19. INTERVENTIONS: Newly initiated on baricitinib or tocilizumab. MEASUREMENTS AND MAIN RESULTS: Our primary outcome was 28-day mortality. We used propensity scores with inverse probability of treatment weights (IPTWs) to control bias and confounding while comparing treatments. Among 10,661 individuals included in the study, 6,229 (58.4%) received baricitinib and 4,432 (41.6%) tocilizumab. Overall, the mean age of the cohort was 60.0±15.1 years, 6429 (60.3%) were male, and 19.2% received invasive mechanical ventilation. After IPTW adjustment, baricitinib use was associated with lower 28-day mortality (odds ratio [OR], 0.91; 95% CI, 0.85–0.98) and hospital (OR, 0.88; 95% CI, 0.82–0.94) mortality compared with tocilizumab. Baricitinib was also associated with shorter hospital length of stay (incident rate ratio, 0.92; 95% CI, 0.90–0.94) and lower rates of hospital-acquired infections (OR, 0.86; 95% CI, 0.75–0.99), although no difference in ICU length of stay was noted between the two groups. CONCLUSIONS: In this large, diverse cohort of U.S. hospitalized adults with COVID-19, baricitinib was associated with significantly lower 28-day mortality, hospital mortality, shorter hospital length of stay, and less hospital-acquired infections compared with tocilizumab.
AB - OBJECTIVES: COVID-19 treatment guidelines recommend baricitinib or tocilizumab for the management of hospitalized patients with COVID-19. We compared the effectiveness of baricitinib vs. tocilizumab on mortality and clinical outcomes among hospitalized patients with COVID-19. DESIGN: Multicenter, retrospective, propensity-weighted cohort study using a target trial emulation approach. SETTING: The National COVID Cohort Collaborative (N3C), which is the largest electronic health records data on COVID-19 in the United States. The setting included 75 hospitals. PATIENTS: Adults who were hospitalized for COVID-19. INTERVENTIONS: Newly initiated on baricitinib or tocilizumab. MEASUREMENTS AND MAIN RESULTS: Our primary outcome was 28-day mortality. We used propensity scores with inverse probability of treatment weights (IPTWs) to control bias and confounding while comparing treatments. Among 10,661 individuals included in the study, 6,229 (58.4%) received baricitinib and 4,432 (41.6%) tocilizumab. Overall, the mean age of the cohort was 60.0±15.1 years, 6429 (60.3%) were male, and 19.2% received invasive mechanical ventilation. After IPTW adjustment, baricitinib use was associated with lower 28-day mortality (odds ratio [OR], 0.91; 95% CI, 0.85–0.98) and hospital (OR, 0.88; 95% CI, 0.82–0.94) mortality compared with tocilizumab. Baricitinib was also associated with shorter hospital length of stay (incident rate ratio, 0.92; 95% CI, 0.90–0.94) and lower rates of hospital-acquired infections (OR, 0.86; 95% CI, 0.75–0.99), although no difference in ICU length of stay was noted between the two groups. CONCLUSIONS: In this large, diverse cohort of U.S. hospitalized adults with COVID-19, baricitinib was associated with significantly lower 28-day mortality, hospital mortality, shorter hospital length of stay, and less hospital-acquired infections compared with tocilizumab.
KW - COVID-19
KW - Janus kinase inhibitors
KW - hospitalization
KW - interleukin-6
KW - mortality
KW - severe acute respiratory syndrome coronavirus 2
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U2 - 10.1097/CCM.0000000000006444
DO - 10.1097/CCM.0000000000006444
M3 - Article
C2 - 39365115
AN - SCOPUS:85207146375
SN - 0090-3493
VL - 53
SP - e29-e41
JO - Critical care medicine
JF - Critical care medicine
IS - 1
ER -