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Comparative Study
. 2025 Jan 1;53(1):e29-e41.
doi: 10.1097/CCM.0000000000006444. Epub 2024 Oct 4.

Comparative Effectiveness of Baricitinib Versus Tocilizumab in Hospitalized Patients With COVID-19: A Retrospective Cohort Study of the National Covid Collaborative

Asad E Patanwala  1   2 , Xuya Xiao  3   4 , Thomas E Hills  5 , Alisa M Higgins  6 , Colin J McArthur  7 , G Caleb Alexander  3   4   8 , Hemalkumar B Mehta  3   4 ; National Covid Cohort Collaborative (N3C) Consortium
Collaborators, Affiliations
Comparative Study

Comparative Effectiveness of Baricitinib Versus Tocilizumab in Hospitalized Patients With COVID-19: A Retrospective Cohort Study of the National Covid Collaborative

Asad E Patanwala et al. Crit Care Med. .

Abstract

Objectives: COVID-19 treatment guidelines recommend baricitinib or tocilizumab for the management of hospitalized patients with COVID-19. We compared the effectiveness of baricitinib vs. tocilizumab on mortality and clinical outcomes among hospitalized patients with COVID-19.

Design: Multicenter, retrospective, propensity-weighted cohort study using a target trial emulation approach.

Setting: The National COVID Cohort Collaborative (N3C), which is the largest electronic health records data on COVID-19 in the United States. The setting included 75 hospitals.

Patients: Adults who were hospitalized for COVID-19.

Interventions: Newly initiated on baricitinib or tocilizumab.

Measurements and main results: Our primary outcome was 28-day mortality. We used propensity scores with inverse probability of treatment weights (IPTWs) to control bias and confounding while comparing treatments. Among 10,661 individuals included in the study, 6,229 (58.4%) received baricitinib and 4,432 (41.6%) tocilizumab. Overall, the mean age of the cohort was 60.0 ± 15.1 years, 6429 (60.3%) were male, and 19.2% received invasive mechanical ventilation. After IPTW adjustment, baricitinib use was associated with lower 28-day mortality (odds ratio [OR], 0.91; 95% CI, 0.85-0.98) and hospital (OR, 0.88; 95% CI, 0.82-0.94) mortality compared with tocilizumab. Baricitinib was also associated with shorter hospital length of stay (incident rate ratio, 0.92; 95% CI, 0.90-0.94) and lower rates of hospital-acquired infections (OR, 0.86; 95% CI, 0.75-0.99), although no difference in ICU length of stay was noted between the two groups.

Conclusions: In this large, diverse cohort of U.S. hospitalized adults with COVID-19, baricitinib was associated with significantly lower 28-day mortality, hospital mortality, shorter hospital length of stay, and less hospital-acquired infections compared with tocilizumab.

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Conflict of interest statement

Dr. Higgins is supported by a National Health and Medical Research Council Investigator Grant (GNT2008447). Dr. Mehta is supported by the National Institute on Aging (1K01AG070329). The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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    1. National Clinical Evidence Taskforce: Evidence-Based Clinical COVID-19 Guidelines. Available at: https://clinicalevidence.net.au/covid-19/ . Accessed May 10, 2023
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    1. Ely EW, Ramanan AV, Kartman CE, et al.; COV-BARRIER Study Group: Efficacy and safety of baricitinib plus standard of care for the treatment of critically ill hospitalised adults with COVID-19 on invasive mechanical ventilation or extracorporeal membrane oxygenation: An exploratory, randomised, placebo-controlled trial. Lancet Respir Med 2022; 10:327–336
    1. RECOVERY Collaborative Group: Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): A randomised, controlled, open-label, platform trial. Lancet 2021; 397:1637–1645

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