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. 2024 Jul 2;25(13):7273.
doi: 10.3390/ijms25137273.

Baricitinib and Pulse Steroids Combination Treatment in Hyperinflammatory COVID-19: A Rheumatological Approach in the Intensive Care Unit

Francesco Ferro  1 , Gaetano La Rocca  1 , Elena Elefante  1 , Nazzareno Italiano  1 , Michele Moretti  1 , Rosaria Talarico  1 , Erika Pelati  2 , Katia Valentini  2 , Chiara Baldini  1 , Roberto Mozzo  2 , Luigi De Simone  2 , Marta Mosca  1
Affiliations

Baricitinib and Pulse Steroids Combination Treatment in Hyperinflammatory COVID-19: A Rheumatological Approach in the Intensive Care Unit

Francesco Ferro et al. Int J Mol Sci. .

Abstract

Hyperinflammatory Coronavirus disease 2019 (COVID-19) and rapidly-progressive interstitial lung diseases (RP-ILD) secondary to inflammatory myopathies (IIM) present important similarities. These data support the use of anti-rheumatic drugs for the treatment of COVID-19. The aim of this study was to compare the efficacy of combining baricitinib and pulse steroids with the Standard of Care (SoC) for the treatment of critically ill COVID-19 patients. We retrospectively enrolled consecutive patients admitted to the Intensive Care Unit (ICU) with COVID-19-pneumonia. Patients treated with SoC (dexamethasone plus remdesivir) were compared to patients treated with baricitinib plus 6-methylprednisolone pulses (Rheuma-group). We enrolled 246 patients: 104/246 in the SoC and 142/246 in the Rheuma-group. All patients presented laboratory findings suggestive of hyperinflammatory response. Sixty-four patients (26.1%) died during ICU hospitalization. The mortality rate in the Rheuma-group was significantly lower than in the SoC-group (15.5 vs. 40.4%, p < 0.001). Compared to the SoC-group, patients in the Rheuma-group presented significantly lower inflammatory biomarker levels after one week of treatment. Higher ferritin levels after one week of treatment were strongly associated with mortality (p < 0.001). In this large real-life COVID-19 cohort, baricitinib and pulse steroids led to a significant reduction in mortality, paralleled by a prompt reduction in inflammatory biomarkers. Our experience supports the similarities between hyperinflammatory COVID-19 and the IIM-associated RP-ILD.

Keywords: COVID-19; baricitinib; ferritin; interstitial lung diseases; pulse steroids.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(a–c). Lung CT-scan sections showing diffuse bilateral and confluent ground-glass opacities with a tendency to lung consolidation, inter- and intra-lobular septal thickening in an enrolled COVID-19 pneumonia patient with severe respiratory failure.
Figure 2
Figure 2
Graphic representation of the C-reactive protein and Ferritin serum levels, clinical course, and corresponding CT findings of the first patient treated with a “Rheumatological approach” after SoC failure. CRP = C Reactive Protein; NIMV = Non-Invasive Mechanical Ventilation; ETI = Endotracheal Intubation.
See this image and copyright information in PMC

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