Baricitinib versus tocilizumab in critically ill COVID-19 patients: A retrospective cohort study.
Baricitinib versus tocilizumab in critically ill COVID-19 patients: A retrospective cohort study.
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巴瑞替尼与托珠单抗治疗重症 COVID-19 患者：一项回顾性队列研究。
DOI：
10.1002/phar.2867
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发表时间：
2024
期刊：
影响因子：
4.1
通讯作者：
Sacha,GretchenL
中科院分区：
文献类型：
--
作者：
Conroy,GraceM;Bauer,SethR;Pallotta,AndreaM;Duggal,Abhijit;Wang,Lu;Sacha,GretchenL
目的免疫调节剂托西珠单抗和巴利西尼改善重症冠状病毒病患者2019年的预后(新冠肺炎)；然而，缺乏与这些制剂相关的临床疗效的比较分析。Tocilizumab在全国范围内的短缺将危重患者的治疗转移到了巴利西尼，从而允许在类似人群中进行结果比较。这项研究的目的是比较接受托西珠单抗和巴利替尼的新冠肺炎危重患者的临床结果。设计采用广义估计方程模型进行的回顾观察队列研究，考虑到按医院和已知混杂因素的分组，估计世界卫生组织临床进展量表序贯评分在第14天，即主要结果的比例优势。次要结果包括世界卫生组织在第7天的CPS评分。克利夫兰临床卫生系统内的多家医院。患者在2021年1月至2021年11月期间因新冠肺炎入院的成人患者。干预措施托西珠单抗在短缺之前或巴利替尼在短缺期间接受治疗。测量和主要结果总共纳入507名患者；217名接受托西珠单抗治疗，290名接受巴利替尼治疗。超过96%的患者需要入住ICU，98%的患者接受地塞米松联合治疗。Tocilizumab接受者的WHO-CPS基线评分较高(较差)。调整后，与巴利替尼(调整后的优势比[OR]1.65[95%可信区间(CI)1.10-2.48])相比，使用tocilizumab与14WHO-CPS评分相比，使用tocilizumab与更糟糕的一天的几率更高。同样，在调整后，使用Tocilizumab与第7天WHO-CPS评分更差的几率更高(调整后OR 1.65[95%CI 1.22-2.24])。结论在一组新冠肺炎危重患者中，在第14天和第7天使用巴利替尼的WHO-CPS评分比Tocilizumab好。在第14天，Tocilizumab的WHO-CPS评分增加一个单位的几率比巴利替尼高71%。在死亡率或不良反应方面没有发现差异。
ObjectivesThe immunomodulators tocilizumab and baricitinib improve outcomes in severely ill patients with coronavirus disease 2019 (COVID‐19); however, comparative analyses of clinical outcomes related to these agents are lacking. A tocilizumab national shortage shifted treatment to baricitinib in critically ill patients, allowing for an outcome comparison in a similar population. The purpose of this study is to compare clinical outcomes in critically ill COVID‐19 patients who received tocilizumab and those who received baricitinib.DesignRetrospective, observational cohort study using generalized estimating equation models, accounting for clustering by hospital and known confounders, to estimate the proportional odds of the ordinal World Health Organization Clinical Progression Scale (WHO‐CPS) score at day 14, the primary outcome. Secondary outcomes included WHO‐CPS score at day 7.SettingMultiple hospitals within the Cleveland Clinic Health System.PatientsAdult patients admitted for COVID‐19 between January 2021 and November 2021.InterventionsReceipt of tocilizumab, before its shortage, or baricitinib, during shortage.Measurements and Main ResultsIn total, 507 patients were included; 217 received tocilizumab and 290 received baricitinib. Over 96% of patients required ICU admission and 98% received concomitant dexamethasone. Tocilizumab recipients had higher (worse) baseline WHO‐CPS scores. After adjustment, tocilizumab use was associated with higher odds of a worse day 14 WHO‐CPS score compared with baricitinib (adjusted odds ratio [OR] 1.65 [95% confidence interval (CI) 1.10–2.48]). Similarly, after adjustment, tocilizumab use was associated with higher odds of a worse day 7 WHO‐CPS score (adjusted OR 1.65 [95% CI 1.22–2.24]).ConclusionsBaricitinib use was associated with better WHO‐CPS scores at day 14 and day 7 compared with tocilizumab in a cohort of critically ill patients with COVID‐19. The odds of having a one unit increase in WHO‐CPS score at day 14 was 71% higher with tocilizumab than baricitinib. No difference in mortality or adverse effects was noted.