Mizuno Tomoki, Suzuki Jun, Takahashi Shota, Imai Haruka, Itagaki Hideya, Yoshida Makiko, Endo Shiro
Division of Infectious Diseases, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8512, Japan; Department of Infection Prevention and Control, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8512, Japan.
Division of Infectious Diseases, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8512, Japan; Department of Infection Prevention and Control, Tohoku Medical and Pharmaceutical University Hospital, 1-12-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8512, Japan; Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8536, Japan.
J Infect Chemother. 2025 Feb;31(2):102531. doi: 10.1016/j.jiac.2024.09.020. Epub 2024 Sep 26.
Systemic baricitinib and corticosteroids play important roles in treating severely and critically ill patients with coronavirus disease 2019 (COVID-19). However, the efficacy of the combination of baricitinib and corticosteroids compared to that of corticosteroid monotherapy in severely and critically ill hospitalized patients with COVID-19 remains unclear.
We analyzed severely and critically ill hospitalized patients with COVID-19 aged >18 years between January 1, 2020 and May 31, 2023, using a Japanese multicenter inpatient database. We performed propensity score matching to analyze the effect of the combination of baricitinib and corticosteroids within 2 days of hospital admission (combination group) on the 28-day and in-hospital mortality rates compared with those of corticosteroid monotherapy within 2 days of hospital admission (control group). Sensitivity analysis was performed using inverse probability weighting analysis and the generalized estimating equation method.
The eligible patients (n = 7433) were divided into a combination (n = 679) and a control group (n = 6754). One-to-four propensity score matching analyses included 566 combination and 2264 control group patients. There was no significant difference in 28-day (8.5 % vs. 8.8 %; risk difference, -0.3 % [95 % confidence interval, -2.9 to 2.3]) or in-hospital (11 % vs. 10 %; risk difference, 1.0 [-1.9 to 3.9]) mortality rates between 2 groups. The sensitivity analysis showed similar outcomes.
This observational study, using a Japanese multicenter inpatient database, found that the combination of baricitinib and corticosteroid therapy did not improve the 28-day or in-hospital mortality rates in severely and critically ill patients with COVID-19 compared to corticosteroid monotherapy.
系统性巴瑞替尼和皮质类固醇在治疗2019冠状病毒病（COVID-19）的重症和危重症患者中发挥着重要作用。然而，在COVID-19重症和危重症住院患者中，与皮质类固醇单药治疗相比，巴瑞替尼与皮质类固醇联合治疗的疗效仍不明确。
我们使用日本多中心住院患者数据库，分析了2020年1月1日至2023年5月31日期间年龄大于18岁的COVID-19重症和危重症住院患者。我们进行倾向评分匹配，以分析入院后2天内巴瑞替尼与皮质类固醇联合治疗（联合组）对28天和住院死亡率的影响，并与入院后2天内皮质类固醇单药治疗（对照组）进行比较。使用逆概率加权分析和广义估计方程法进行敏感性分析。
符合条件的患者（n = 7433）分为联合组（n = 679）和对照组（n = 6754）。一对一至四对倾向评分匹配分析纳入了566例联合组患者和2264例对照组患者。两组之间的28天死亡率（8.5%对8.8%；风险差异，-0.3%[95%置信区间，-2.9至2.3]）或住院死亡率（11%对10%；风险差异，1.0[-1.9至3.9]）无显著差异。敏感性分析显示了相似的结果。
这项使用日本多中心住院患者数据库的观察性研究发现，与皮质类固醇单药治疗相比，巴瑞替尼与皮质类固醇联合治疗并未改善COVID-19重症和危重症患者的28天或住院死亡率。
