Baricitinib plus corticosteroids benefits pulmonary function in SARS-CoV-2 pneumonia

The combination of baricitinib plus corticosteroids (BCT-CS) appears to produce meaningful improvements in pulmonary function in patients with moderate to severe SARS-CoV-2 pneumonia compared with corticosteroids alone, as shown in a study.

The analysis included 112 patients (median age, 63 years; 69.6 percent male) with arterial oxygen partial pressure (PaO₂)/fraction of inspired oxygen (FiO₂) of <200 mm Hg. All of them received background lopinavir/ritonavir and hydroxychloroquine; 50 patients also received corticosteroids (CS group) while 62 patients received corticosteroids together with baricitinib.

Improvements observed in oxygen saturation, assessed by pulse oximetry (SpO₂)/FiO₂, from hospitalization to discharge were significantly greater in the BCT-CS vs the CS group (mean difference, 49, 95 percent confidence interval [CI], 22–77; p<0.001).

Furthermore, significantly more patients in the CS than in the BCT-CS group required supplemental oxygen both at discharge (62.0 percent vs 25.8 percent; reduction of the risk, 82 percent; odds ratio [OR], 0.18, 95 percent CI, 0.08–0.43; p<0.001) and 1 month later (28.0 percent vs 12.9 percent; reduction of the risk, 69 percent; OR, 0.31, 95 percent CI, 0.11–0.86; p=0.024).

The present data indicate a possible synergistic biological effect of baricitinib when combined with corticosteroids in moderate to severe SARS-CoV-2 pneumonia. This combination appears to be a reasonably effective and safe treatment option for patients at risk of intensive care unit admission/mechanical ventilation.

More studies are needed to determine the optimal timing for starting baricitinib relative to onset of symptoms—that is whether the drug could be used earlier in patients with less severe respiratory failure—and the dose and duration of treatment.