托珠单抗与皮质类固醇治疗对比巴瑞替尼与皮质类固醇治疗在2019冠状病毒病重症和危重症患者中的应用

Comparison of tocilizumab and corticosteroid treatment with baricitinib and corticosteroid treatment in severely and critically ill patients with coronavirus disease 2019.

作者信息

Itagaki Hideya, Suzuki Jun, Mizuno Tomoki, Takahashi Shota, Imai Haruka, Yoshida Makiko, Endo Shiro

机构信息

Division of Infectious Diseases and Infection Control, Department of Social and Community Medicine, Graduate School of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai City, Miyagi, 983-8536, 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.

出版信息

Respir Investig. 2025 Sep;63(5):949-954. doi: 10.1016/j.resinv.2025.07.011. Epub 2025 Jul 31.

DOI:10.1016/j.resinv.2025.07.011

PMID:40749360

Abstract

BACKGROUND

Several guidelines recommend that systemic therapies involving tocilizumab, baricitinib, and corticosteroids are crucial in treating severely and critically ill patients with coronavirus disease 2019 (COVID-19). However, the efficacy of the tocilizumab and corticosteroid combination compared with the baricitinib and corticosteroid combination in severely and critically ill hospitalized patients with COVID-19 remains unclear.

METHODS

We analyzed severely and critically ill hospitalized patients with COVID-19 aged ≥18 years between 1 January 2020 and 31 March 2023 using a Japanese inpatient database. Propensity score matching was performed to compare the effects of the tocilizumab plus corticosteroid and baricitinib plus corticosteroid combinations (tocilizumab and baricitinib groups, respectively) within 2 days of hospitalization on the in-hospital mortality rate related to COVID-19.

RESULTS

Of the 197,507 hospitalized patients with COVID-19 in our database, those eligible were divided into the tocilizumab and baricitinib groups (n = 244 and 665, respectively). The one-to-one propensity score-matching analysis created 198 pairs. Before propensity score matching, the in-hospital mortality rate related to COVID-19 was higher in the tocilizumab group than in the baricitinib group (20.5 % vs. 9.0 %, P < 0.001). In contrast, after propensity score matching, no significant intergroup difference was observed in the in-hospital mortality rate related to COVID-19 (16.7 % vs. 11.1 %, P = 0.143).

CONCLUSIONS

This observational study showed that the tocilizumab and corticosteroid combination did not reduce in-hospital mortality rates in severely and critically ill patients with COVID-19 compared with the baricitinib and corticosteroid combination.

摘要

背景

多项指南推荐，托珠单抗、巴瑞替尼和皮质类固醇的全身治疗对治疗2019冠状病毒病（COVID-19）的重症和危重症患者至关重要。然而，在COVID-19重症和危重症住院患者中，托珠单抗与皮质类固醇联合使用与巴瑞替尼与皮质类固醇联合使用相比的疗效仍不明确。

方法

我们使用日本住院患者数据库分析了2020年1月1日至2023年3月31日期间年龄≥18岁的COVID-19重症和危重症住院患者。进行倾向评分匹配，以比较住院2天内托珠单抗加皮质类固醇和巴瑞替尼加皮质类固醇联合治疗（分别为托珠单抗组和巴瑞替尼组）对COVID-19相关院内死亡率的影响。

结果

在我们数据库中的197,507例COVID-19住院患者中，符合条件的患者被分为托珠单抗组和巴瑞替尼组（分别为n = 244和665）。一对一倾向评分匹配分析产生了198对。在倾向评分匹配前，托珠单抗组COVID-19相关院内死亡率高于巴瑞替尼组（20.5%对9.0%，P < 0.001）。相比之下，倾向评分匹配后，COVID-19相关院内死亡率在组间未观察到显著差异（16.7%对11.1%，P = 0.143）。