Clinical impact of combination therapy with baricitinib, remdesivir, and dexamethasone in patients with severe COVID-19

Abstract

Background Coronavirus disease 2019 (COVID-19) has spread worldwide and is also an important disease in Japan. Thus, the optimal treatment strategy for severe COVID-19 should be established urgently. The effects of combination treatment with baricitinib—a Janus kinase inhibitor, remdesivir, and dexamethasone (BRD) are unknown. Methods Patients who received combination therapy with BRD at the Japanese Red Cross Medical Center were enrolled in the study. All patients received baricitinib (≤14 d), remdesivir (≤10 d), and dexamethasone (≤10 d). The efficacy and adverse events were evaluated. Results In total, 44 patients with severe COVID-19 were enrolled in this study. The 28-d mortality rate was low at 2.3 % (1/44 patients). The need for invasive mechanical ventilation was avoided in most patients (90 %, 17/19 patients). Patients who received BRD therapy had a median hospitalization duration of 11 d, time to recovery of 9 d, duration of intensive care unit stay of 6 d, duration of invasive mechanical ventilation of 5 d, and duration of supplemental oxygen therapy of 5 d. Adverse events occurred in 15 patients (34 %). Liver dysfunction, thrombosis, iliopsoas hematoma, renal dysfunction, ventilator-associated pneumonia, infective endocarditis, and herpes zoster occurred in 11 %, 11 %, 2 %, 2 %, 2 %, 2 %, and 2 % of patients, respectively. Conclusions Combination therapy with BRD was effective in treating severe COVID-19, and the incidence rate of adverse events was low. The results of the present study are encouraging; however, further randomized clinical studies are needed.

A Comprehensive Overview of Globally Approved JAK Inhibitors

“…The results of the clinical trial of baricitinib in combination with remdesivir (NCT04401579) revealed superior activity in reducing the recovery period compared to remdesivir alone [ 92 ]. Similar results were also obtained when using a combination of dexamethasone with baricitinib/remdesivir [ 93 ]. Finally, the combination of baricitinib and remdesivir received an Emergency Use Authorization (EUA) from the FDA to treat hospitalized patients with COVID-19.…”

Efficacy of COVID-19 treatments among geriatric patients: a systematic review

“…In Izumo et al , 53 an observational study of 44 patients with severe COVID-19 received triple therapy of BNB (4 mg daily oral), RMD (IV 200 mg loading, 100 mg maintenance daily) and DMS (oral or IV 6 mg daily). It was found that patients who received BNB had a low mortality rate (2.3%) and decrease in mechanical ventilation requirement (90%) with approximately 34% adverse events observed.…”

“…It was found that patients who received BNB had a low mortality rate (2.3%) and decrease in mechanical ventilation requirement (90%) with approximately 34% adverse events observed. 53 …”

Efficacy of the combination of baricitinib, remdesivir, and dexamethasone in hypoxic adults with COVID-19: A retrospective study

“…Previously, Izumo et al. reported that triple therapy was effective with 2.3% mortality rate [6] . Thus, the add-on efficacy of baricitinib was expected in hypoxic patients with COVID-19.…”