Baricitinib plus Remdesivir Helpful for Patients Hospitalized with COVID-19

Adding arthritis drug baricitinib to remdesivir may reduce recovery time in adult patients hospitalized with COVID-19, according to a study.

Eli Lilly, the manufacturer of baricitinib—marketed as Olumiant—announced in September that the results of a study indicated the benefit of adding baricitinib to remdesivir, citing the phase 3, randomized, double-blind, placebo-controlled Adaptive COVID-19 Treatment Trial (ACTT-2), which is sponsored by the National Institute of Allergy and Infectious Diseases, a branch of the National Institutes of Health. However, the results of the study were not available in full until they were published in The New England Journal of Medicine on Friday.

Patients in ACTT-2 were hospitalized adults with COVID-19. They all received remdesivir (≤10 days) and either baricitinib (≤14 days) or placebo. Time to recovery was the main outcome, with 15-day clinical status assessed as a key secondary outcome.

The study randomized 1,033 patients: 515 received baricitinib and 518 received placebo. The median time to recovery was one day shorter in the baricitinib group compared to the control group (7 days [95% confidence interval (CI), 6-8] vs. 8 days [95% CI, 7-9]) (rate ratio for recovery, 1.16; 95% CI, 1.01-1.32; P=0.03). The baricitinib group was also 30% more likely to have improved clinical status at day 15 (odds ratio, 1.3; 95% CI, 1.0-1.6). For patients receiving high-flow oxygen or noninvasive ventilation at the start of the study, the difference in time to recovery was more significant, with a median 10 days in the baricitinib group and 18 days in the control group (rate ratio for recovery, 1.51; 95% CI, 1.10-2.08).

The rate of 28-day mortality was slightly lower in the baricitinib group than the control group (5.1% vs. 7.8%; hazard ratio for death, 0.65; 95% CI, 0.39-1.09). Baricitinib patients were also less likely to sustain serious adverse evens (16% vs. 21%; difference, -5 percentage points; 95% CI, -9.8 to -0.3; P=0.03) and new infections (5.9% vs. 11.2%; difference, -5.3 percentage points; 95% CI, -8.7 to -1.9; P=0.003).

A previous observational study found that baricitinib plus corticosteroids, compared to corticosteroids alone, was associated with improved pulmonary function in patients with COVID-19 pneumonia.