Tocilizumab vs. baricitinib in hospitalized severe COVID-19 patients: results from a real-world cohort

Abstract

Background Tocilizumab and baricitinib are recommended treatment options for hospitalized COVID-19 patients requiring oxygen support. Literature about its efficacy and safety in a head-to-head comparison is scarce. Methods Hospitalized COVID-19 patients requiring oxygen were treated with tocilizumab or baricitinib additionally to dexamethasone. Tocilizumab was available from February till the 19th of September 2021 and baricitinib from 21st of September. The primary outcome was in-hospital mortality. Secondary outcome parameters were progression to mechanical ventilation (MV), length-of-stay (LOS) and potential side effects. Results 159 patients (tocilizumab 68, baricitinib 91) with a mean age of 60.5 years, 64% male were included in the study. Tocilizumab patients were admitted 1 day earlier, were in a higher WHO category at the time of inclusion and had a higher CRP level on admission and treatment initiation. Patients receiving Tocilizumab were treated with remdesivir more often and only patients in the baricitinib group were treated with monoclonal antibodies. Other characteristics did not differ significantly. In-hospital mortality (18% vs. 11%, p = 0.229), progression to MV (19% vs. 11%, p = 0.173) and LOS (13 vs. 12 days, p = 0.114) did not differ between groups. Side effects were equally distributed between groups, except ALAT elevation which was significantly more often observed in the tocilizumab group (43% vs. 25%, p = 0.021). Conclusions In-hospital mortality, progression to MV and LOS were not significantly different in patients treated with tocilizumab or baricitinib additionally to standard of care. Both drugs seem equally effective but further head-to-head trials are needed.

Efficacy and safety of tocilizumab and baricitinib among patients hospitalized for COVID-19: a systematic review and meta-analysis

“…A network meta-analysis was conducted to assess the efficacy and safety of immunomodulators in patients with COVID-19, revealing that tocilizumab may pose a higher risk of infection compared to baricitinib (Ngamprasertchai et al, 2022). Other studies have additionally indicated an elevation in the incidence of thrombosis or acute liver injury among individuals administered tocilizumab as opposed to baricitinib (Karolyi et al, 2023;Peterson et al, 2023;Reid et al, 2023). Our study found that the tocilizumab group had adverse effects more frequently, including secondary infections, thrombotic events, and acute liver damage.…”

Clinical Outcomes among Hospitalized COVID-19 Patients Who Received Baricitinib or Tocilizumab in Addition to Standard of Care

“…The 28-day mortality rate is only the secondary outcome reported in the overall group and it was shown to be significantly lower in the baricitinib group (tocilizumab 49% vs. baricitinib 39%, p = 0.001). Karolyi et al (2021) showed that, among 159 patients with COVID-19 infection, hospital mortality, progression to MV, and hospital LOS were higher in the tocilizumab group but these results were not statistically significant at, respectively, 18% vs. 11% (p = 0.229), 19% vs. 11% (p = 0.173), and 13 vs. 12 days (p = 0.114) [22]. Two other similar but smaller studies also showed the same finding of no significant mortality rate.…”

Assessment of the Efficacy and Safety of Baricitinib Treatment in COVID-19 Patients: a real-world study

“…Several observational cohort studies have indicated that BAR reduces mortality and the risk of progression to invasive mechanical ventilation in hospitalized patients with COVID-19 infection. Moreover, when compared to tocilizumab, BAR has been associated with a lower risk of elevated liver enzyme levels [16][17][18]. The collective randomized evidence available to date indicates that JAK inhibitors, primarily BAR, decrease mortality in patients hospitalized for COVID-19 by approximately one-fth [18].…”