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Baricitinib and dexamethasone for hospitalized patients with COVID-19

Leonard H Calabrese1, Cassandra Calabrese2

  • 1Department of Rheumatic and Immunologic| Diseases, Orthopedic & Rheumatologic Institute, Cleveland Clinic; Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH calabrl@ccf.org.

Cleveland Clinic Journal of Medicine
|February 2, 2021
PubMed

Insights

For hospitalized COVID-19 patients with lung inflammation or low oxygen, dexamethasone or baricitinib with remdesivir are recommended. Do not use both treatments together, as superiority is unproven and further trials are ongoing.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • The cytokine storm in critically ill COVID-19 patients necessitates anti-inflammatory treatments.
  • Dexamethasone is the established standard of care for managing this hyperinflammatory state.
  • Baricitinib, a Janus kinase inhibitor, combined with remdesivir, is an alternative approved treatment.

Purpose of the Study:

  • To compare the efficacy and safety of dexamethasone versus baricitinib plus remdesivir in hospitalized COVID-19 patients.
  • To provide guidance on the optimal use of these two treatment regimens.

Main Methods:

  • Review of randomized controlled trials evaluating dexamethasone and baricitinib plus remdesivir.
  • Analysis of clinical outcomes, including mortality, inflammatory markers, and respiratory support requirements.
  • Assessment of evidence for combined use of the two regimens.

Main Results:

  • Both dexamethasone and baricitinib plus remdesivir have demonstrated clinical benefits in treating COVID-19 pneumonia.
  • Current evidence does not establish the superiority of one regimen over the other.
  • Data on the combined use of both regimens is insufficient to recommend their concurrent administration.

Conclusions:

  • For hospitalized COVID-19 patients with pneumonitis or hypoxia, either dexamethasone or baricitinib with remdesivir can be used.
  • Concurrent use of both treatment regimens is not recommended due to lack of proven benefit and potential risks.
  • Further clinical trials are needed to definitively determine the optimal treatment strategy and the role of combination therapy.

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