A Novel Report on the Compassionate Use of Baricitinib in Treating a Pediatric Patient With Severe Symptoms of COVID-19 Infection

Abstract

Since the outbreak of the pandemic coronavirus disease 2019 (COVID-19), there has been an increasing need for treatment to decrease morbidity and mortality of patients presenting with severe disease symptoms. There has been increasing evidence to suggest that the pathophysiological basis is a severe inflammatory response that resembles the cytokine release syndrome. Current strategies to counteract this involve modifiers of the immune response such as interleukin (IL)-6 receptor blockers and Janus kinase (JAK) inhibitors. An example of a JAK inhibitor is baricitinib. In this case, we present a 17-year-old female admitted with severe COVID-19 symptoms, who was placed on high-flow nasal cannula and started on azithromycin and hydroxychloroquine, which were standard of care at the time. Due to the worsening of symptoms, she was given baricitinib for compassionate use. There was a rapid improvement in clinical and imaging findings, and the patient was discharged from the hospital within 8 days of admission. This study is fascinating because there are very limited studies published on the benefits of baricitinib in managing patients with severe symptoms of COVID-19 especially in the pediatric population, and the rapidity in recovery time was remarkable.

Janus kinase inhibitors and major COVID-19 outcomes: time to forget the two faces of Janus! A meta-analysis of randomized controlled trials

“…In addition, it would be of interest to assess their clinical efficacy regarding major outcomes in patients infected with the newly identified SARS-CoV-2 variants, such as delta variant, which now account for the vast majority of newly diagnosed cases worldwide. Of course, their efficacy might also be tested in the pediatric population, since there are only some sparse relevant reports in the literature [ 14 ]. Another question that arises is whether this drug class has a clear and direct impact on associated COVID-19 complications, such as coagulopathy in the context of the disease [ 15 ].…”

Clinical efficacy and safety of Janus kinase inhibitors for COVID-19: A systematic review and meta-analysis of randomized controlled trials

“…Janus kinase (JAK) inhibitors can downregulate the JAK/signal transducer and activator of transcription protein signaling pathways and decrease cytokine concentrations, and therefore they have been proposed as a potential therapies to mitigate the immune response and prevent a hyperinflammatory state, which may further improve clinical outcomes of hospitalized COVID-19 patients [7] , [8] , [9] , [10] . The clinical uses of JAK inhibitors, including ruxolitinib, baricitinib, and tofacitinib for COVID-19 patients have been reported in many observational studies [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , in which adding JAK inhibitors could help resolve a hyperinflammatory state, improve respiratory function, reduce mortality, and increase survival discharge for patients with SARS-CoV-2 infections. Although two meta-analyses [19] , [20] assessed the efficacy of JAK inhibitors on the clinical outcomes of COVID-19 patients, cohort studies or non-randomized controlled trials (RCTs) comprised more than half of the included studies, and only two RCTs [21] , [22] were included in these two meta-analyses.…”

Oral anti-COVID-19 drugs that were recently evaluated by FDA or EMA: a review

“…In most cases, the drug contributes to the reduction of mortality rate and recovery duration in patients with moderate or severe COVID-19 pneumonia [69][70][71][72][73][74], either along with other drugs or alone [75][76][77][78][79][80][81][82]. Its effectiveness has been shown in pediatric patients with severe COVID-19 as well [83]. Moreover, baricitinib is proved to cease the progression to severe pneumonia [84].…”