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.