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A Risk Profile Using Simple Hematologic Parameters to Assess Benefits From Baricitinib in Patients Hospitalized With
Catharine I Paules1, Jing Wang2, Kay M Tomashek3
1Division of Infectious Diseases, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (C.I.P.).
Annals of Internal Medicine
|February 26, 2024
Summary
Hospitalized COVID-19 patients in a high-risk group showed improved outcomes with baricitinib plus remdesivir. This immunomodulator treatment reduced mortality and enhanced recovery in severe cases.
Area of Science:
- Infectious Diseases
- Immunology
- Critical Care Medicine
Background:
- The ACTT risk profile identified high-risk COVID-19 patients (low ALC, high ANC, low platelets) benefiting from remdesivir.
- Benefit from baricitinib, an immunomodulator, in specific COVID-19 patient subgroups remained unclear.
Purpose of the Study:
- To evaluate baricitinib treatment effects in COVID-19 patients stratified by the ACTT risk profile.
- To identify patient characteristics associated with baricitinib benefit in hospitalized COVID-19 patients.
Main Methods:
- Post hoc analysis of the randomized, double-blind, placebo-controlled ACTT-2 trial (NCT04401579).
- Included 999 hospitalized adult COVID-19 patients, with baricitinib+remdesivir compared to placebo+remdesivir.
- Assessed mortality, progression to invasive mechanical ventilation (IMV) or death, recovery, and blood cell count trajectories within 28 days.
Main Results:
- In the high-risk quartile, baricitinib+remdesivir significantly reduced the risk of death (HR 0.38) and progression to IMV or death (HR 0.57).
- Improved recovery rates (HR 1.53) were observed in the high-risk group receiving baricitinib+remdesivir.
- Baricitinib+remdesivir led to greater increases in absolute lymphocyte count (ALC) and decreases in absolute neutrophil count (ANC), particularly in high-risk patients.
Conclusions:
- The ACTT risk profile identifies COVID-19 patients who benefit most from baricitinib treatment.
- Baricitinib, as an immunomodulator, combined with an antiviral, demonstrates a potential mechanism for limiting severe COVID-19 progression through modulation of ALC and ANC levels.
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