Comparison of tocilizumab and corticosteroid treatment with baricitinib and corticosteroid treatment in severely and critically ill patients with coronavirus disease 2019.

BACKGROUND: Several guidelines recommend that systemic therapies involving tocilizumab, baricitinib, and corticosteroids are crucial in treating severely and critically ill patients with coronavirus disease 2019 (COVID-19). However, the efficacy of the tocilizumab and corticosteroid combination compared with the baricitinib and corticosteroid combination in severely and critically ill hospitalized patients with COVID-19 remains unclear.

METHODS: We analyzed severely and critically ill hospitalized patients with COVID-19 aged ≥18 years between 1 January 2020 and 31 March 2023 using a Japanese inpatient database. Propensity score matching was performed to compare the effects of the tocilizumab plus corticosteroid and baricitinib plus corticosteroid combinations (tocilizumab and baricitinib groups, respectively) within 2 days of hospitalization on the in-hospital mortality rate related to COVID-19.

RESULTS: Of the 197,507 hospitalized patients with COVID-19 in our database, those eligible were divided into the tocilizumab and baricitinib groups (n = 244 and 665, respectively). The one-to-one propensity score-matching analysis created 198 pairs. Before propensity score matching, the in-hospital mortality rate related to COVID-19 was higher in the tocilizumab group than in the baricitinib group (20.5 % vs. 9.0 %, P < 0.001). In contrast, after propensity score matching, no significant intergroup difference was observed in the in-hospital mortality rate related to COVID-19 (16.7 % vs. 11.1 %, P = 0.143).

CONCLUSIONS: This observational study showed that the tocilizumab and corticosteroid combination did not reduce in-hospital mortality rates in severely and critically ill patients with COVID-19 compared with the baricitinib and corticosteroid combination.