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Editorial
. 2021 Mar 4;384(9):867-869.
doi: 10.1056/NEJMe2034982.

Baricitinib Therapy in Covid-19 Pneumonia - An Unmet Need Fulfilled

Delia Goletti  1 , Fabrizio Cantini  1
Affiliations
Editorial

Baricitinib Therapy in Covid-19 Pneumonia - An Unmet Need Fulfilled

Delia Goletti et al. N Engl J Med. .
No abstract available

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Figures

Figure 1
Figure 1. Evidence-based Efficacy of Covid-19 Therapies, According to Disease Severity.
The clinical course of coronavirus disease 2019 (Covid-19) is characterized at the outset by mild symptoms of the upper respiratory tract. During this stage, the viral load of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) peaks, with progressive lowering afterward. After 7 or 8 days, in 20% of patients the disease progresses to bilateral pneumonia. This second stage is characterized by a massive immune response, with subsequent worsening of the lung damage, respiratory failure often requiring invasive mechanical ventilation, and other organ dysfunction. To date, on the basis of controlled trials, the antiviral remdesivir, the antiinflammatory dexamethasone, and the Janus kinase inhibitor baricitinib are considered to be the best treatment options for Covid-19. Baricitinib fulfills the unmet need of providing efficacious therapies for the gray zone of treatments for pneumonia requiring oxygen support (ordinal scale of 5 or 6). The yellow gradation is from the lower expected beneficial effect of the drug (light yellow) to the highest (orange). The blue gradation is from the lower expected SARS-CoV-2 replication (light blue) to the highest (dark blue). The red gradation is from the lower SARS-CoV-2–mediated immune response (pink) to the highest (red). In the Randomized Evaluation of Covid-19 Therapy trial, mortality was lower with dexamethasone than with usual care among patients receiving invasive ventilation (assumed ordinal score of 7) and, to a lesser extent, among those receiving oxygen only (assumed score of 5 or 6). However, no indication of the level of oxygen support was provided (ordinal score of 5 or 6). We arbitrarily added it. ECMO denotes extracorporeal membrane oxygenation, and NIAID National Institute of Allergy and Infectious Diseases.
See this image and copyright information in PMC

Comment on

  • Baricitinib plus Remdesivir for Hospitalized Adults with Covid-19.
    Kalil AC, Patterson TF, Mehta AK, Tomashek KM, Wolfe CR, Ghazaryan V, Marconi VC, Ruiz-Palacios GM, Hsieh L, Kline S, Tapson V, Iovine NM, Jain MK, Sweeney DA, El Sahly HM, Branche AR, Regalado Pineda J, Lye DC, Sandkovsky U, Luetkemeyer AF, Cohen SH, Finberg RW, Jackson PEH, Taiwo B, Paules CI, Arguinchona H, Erdmann N, Ahuja N, Frank M, Oh MD, Kim ES, Tan SY, Mularski RA, Nielsen H, Ponce PO, Taylor BS, Larson L, Rouphael NG, Saklawi Y, Cantos VD, Ko ER, Engemann JJ, Amin AN, Watanabe M, Billings J, Elie MC, Davey RT, Burgess TH, Ferreira J, Green M, Makowski M, Cardoso A, de Bono S, Bonnett T, Proschan M, Deye GA, Dempsey W, Nayak SU, Dodd LE, Beigel JH; ACTT-2 Study Group Members. Kalil AC, et al. N Engl J Med. 2021 Mar 4;384(9):795-807. doi: 10.1056/NEJMoa2031994. Epub 2020 Dec 11. N Engl J Med. 2021. PMID: 33306283 Free PMC article. Clinical Trial.

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