Baricitinib Combo for COVID-19 Accelerates Recovery, Study Shows

Jake Remaly

December 11, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Among people hospitalized with COVID-19, a combination of baricitinib and remdesivir reduces the median time to recovery compared with remdesivir plus placebo, according to trial results published December 11 in the New England Journal of Medicine.

Median time to recovery was 7 days for patients who received baricitinib versus 8 days for patients who received placebo.

The difference was greater in patients who required high-flow oxygen or noninvasive ventilation during their hospitalization. In this group, baricitinib shortened median time to recovery from 18 days to 10 days.

"Baricitinib plus remdesivir was superior to remdesivir alone in reducing recovery time and accelerating improvement in clinical status, notably among patients receiving high-flow oxygen or noninvasive mechanical ventilation," reported Andre C. Kalil, MD, MPH, from the University of Nebraska Medical Center in Omaha, and colleagues. In addition, the combination was associated with fewer adverse events.

The study details data from the ACTT-2 trial that the US Food and Drug Administration (FDA) used to issue an emergency use authorization (EUA) for baricitinib in combination with remdesivir on November 19.

Under the EUA, baricitinib (Olumiant, Eli Lilly), a janus kinase inhibitor approved for the treatment of rheumatoid arthritis, may be used in combination with remdesivir (Veklury, Gilead), an antiviral, for treating hospitalized adults and children at least 2 years old with suspected or confirmed COVID-19.

The combination is intended for patients who need supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation.

Combo Treatment Favored

It is unclear how baricitinib compares with dexamethasone, which improved survival and led to a 1-day shorter hospital stay in another trial, the researchers noted. There are differences between the drugs and trial designs, and only a "head-to-head comparison...will allow the efficacy and safety differences between these two approaches to be fully understood," Kalil and coauthors said.

"Dexamethasone has a long half-life, acts on glucocorticoid receptors, and reduces inflammation through a broad-pathway approach that has been associated with immunosuppression, hospital-acquired infections, gastrointestinal bleeding, hyperglycemia, and neuromuscular weakness, even with short courses," they said. "Baricitinib has a short half-life, acts on targeted critical pathways to reduce inflammation while minimizing biologic redundancy with less immunosuppression, and may have antiviral activity."

The ACTT-2 trial started in May and enrolled 1033 patients in eight countries. Participants were randomly assigned to receive oral baricitinib tablets plus intravenous remdesivir or oral placebo tablets plus remdesivir. 

Participants who received both drugs had significantly improved clinical status at day 15. Patients who received both treatments also had fewer serious adverse events.

"Although ACTT-2 was not powered to detect a difference in mortality between the two groups, both the survival rate and the time-to-death analyses favored combination treatment," the researchers said.

The trial was sponsored by the National Institute of Allergy and Infectious Diseases. Some of the authors disclosed funding from government grants and financial ties to Eli Lilly, Gilead, and other companies.

N Engl J Med. Published online December 11, 2020. Full text

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