Patanwala Asad E, Xiao Xuya, Hills Thomas E, Higgins Alisa M, McArthur Colin J, Alexander G Caleb, Mehta Hemalkumar B
Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, NSW, Australia.
Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Crit Care Med. 2025 Jan 1;53(1):e29-e41. doi: 10.1097/CCM.0000000000006444. Epub 2024 Oct 4.
COVID-19 treatment guidelines recommend baricitinib or tocilizumab for the management of hospitalized patients with COVID-19. We compared the effectiveness of baricitinib vs. tocilizumab on mortality and clinical outcomes among hospitalized patients with COVID-19.
Multicenter, retrospective, propensity-weighted cohort study using a target trial emulation approach.
The National COVID Cohort Collaborative (N3C), which is the largest electronic health records data on COVID-19 in the United States. The setting included 75 hospitals.
Adults who were hospitalized for COVID-19.
Newly initiated on baricitinib or tocilizumab.
Our primary outcome was 28-day mortality. We used propensity scores with inverse probability of treatment weights (IPTWs) to control bias and confounding while comparing treatments. Among 10,661 individuals included in the study, 6,229 (58.4%) received baricitinib and 4,432 (41.6%) tocilizumab. Overall, the mean age of the cohort was 60.0 ± 15.1 years, 6429 (60.3%) were male, and 19.2% received invasive mechanical ventilation. After IPTW adjustment, baricitinib use was associated with lower 28-day mortality (odds ratio [OR], 0.91; 95% CI, 0.85-0.98) and hospital (OR, 0.88; 95% CI, 0.82-0.94) mortality compared with tocilizumab. Baricitinib was also associated with shorter hospital length of stay (incident rate ratio, 0.92; 95% CI, 0.90-0.94) and lower rates of hospital-acquired infections (OR, 0.86; 95% CI, 0.75-0.99), although no difference in ICU length of stay was noted between the two groups.
In this large, diverse cohort of U.S. hospitalized adults with COVID-19, baricitinib was associated with significantly lower 28-day mortality, hospital mortality, shorter hospital length of stay, and less hospital-acquired infections compared with tocilizumab.
新型冠状病毒肺炎（COVID-19）治疗指南推荐使用巴瑞替尼或托珠单抗治疗COVID-19住院患者。我们比较了巴瑞替尼与托珠单抗对COVID-19住院患者死亡率和临床结局的疗效。
采用目标试验模拟方法的多中心、回顾性、倾向加权队列研究。
美国国家COVID队列协作研究（N3C），这是美国最大的关于COVID-19的电子健康记录数据。研究背景包括75家医院。
因COVID-19住院的成年人。
新开始使用巴瑞替尼或托珠单抗。
我们的主要结局是28天死亡率。在比较治疗方法时，我们使用倾向评分与治疗权重的逆概率（IPTW）来控制偏倚和混杂因素。在纳入研究的10661名个体中，6229名（58.4%）接受了巴瑞替尼治疗，4432名（41.6%）接受了托珠单抗治疗。总体而言，该队列的平均年龄为60.0±15.1岁，6429名（60.3%）为男性，19.2%接受了有创机械通气。经过IPTW调整后，与托珠单抗相比，使用巴瑞替尼与较低的28天死亡率（优势比[OR]，0.91；95%置信区间[CI]，0.85-0.98）和住院死亡率（OR，0.88；95%CI，0.82-0.94）相关。巴瑞替尼还与较短的住院时间（发生率比，0.92；95%CI，0.90-0.94）和较低的医院获得性感染率（OR，0.86；95%CI，0.75-0.99）相关，尽管两组在重症监护病房（ICU）住院时间上没有差异。
在这个来自美国的、多样化的COVID-19住院成年人群体中，与托珠单抗相比，巴瑞替尼与显著更低的28天死亡率、住院死亡率、更短的住院时间以及更少的医院获得性感染相关。
