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Abstract
Background and importance A randomised clinical trial has demonstrated that baricitinib reduces the mortality of patients with SARS-CoV-2 that require hospitalisation. However, the evolution of biomarkers that predict the patients’ outcome is not well described.
Aim and objectives To analyse the evolution of biomarkers in hospitalised adults with SARS-CoV-2 pneumonia treated with baricitinib.
Material and methods We conducted a retrospective observational study in a tertiary university hospital (760 beds). We included 31 patients positive for SARS-CoV-2 between January and February 2021. All received baricitinib 4 mg daily for ≥5 days (2 mg daily if glomerular filtration <60 mL/min).
We evaluated five biomarkers: lymphocytes, C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH) and D-dimer. The results were obtained on the day of admission (D+0) and on days 2 (D+2), 5 (D+5), 7 (D+7) and 10 (D+10) after starting baricitinib.
A pharmacist was involved in the multidisciplinary team taking part in COVID-19 protocol drafting, validation of treatments, dose adjustments, interactions, and monitoring of adverse effects.
The REDCap database was used for data collection and the G-STAT-2.0.1 for statistical analysis (paired t-test/Holm–Bonferroni correction).
Results A total of 31 patients were included: 6 women and 25 men. Median age (IQR) was 64 (55;75) years.
Main comorbidities were dyslipidaemia (39%), hypertension (35%), pulmonary disease (29%), diabetes (16%) and cardiopathy (16%). During admission, 15 (48%) received corticosteroids and 18 (58%) remdesivir, 7 (23%) needed high-flow oxygen, 5 (16%) required intensive care unit (ICU) admission and 2 (6%) died.
Baseline biomarkers, as median (IQR), were: CRP 8.2 (5;11) mg/dL, ferritin 402 (176;794) ng/mL, LDH 280 (237;340) U/L, lymphocytes 0.6 (0.4;0.9) 109/L and D-dimer 500 (300;700) ng/mL.
The change in the biomarkers is shown in Figure 1. There was a decrease in CRP which was statistically significant from D+5 (p=0.0144) onwards and an increase in lymphocyte count significant from D+2 (p=0.0148) onwards. LDH, ferritin and D-dimer did not significantly improve. No patient had thromboembolic complications or other adverse reactions associated with treatment.
Evolution of biomarkers from day 0 (D+0) to day 10 (D+10) after initiation of baricitinib treatment
Conclusion and relevance Patients with severe SARS-CoV-2 pneumonia treated with baricitinib showed a significant increase in lymphocyte counts as well as a significant decrease in CRP shortly after baricitinib treatment. This fact, together with the low mortality, and good tolerance supports the use of baricitinib for patients with COVID-19 pneumonia.
Conflict of interest No conflict of interest