Baricitinib reduces 30‐day mortality in older adults with moderate‐to‐severe COVID‐19 pneumonia

Background Older adults are at the highest risk of severe disease and death due to COVID‐19. Randomized data have shown that baricitinib improves outcomes in these patients, but focused stratified analyses of geriatric cohorts are lacking. Our objective was to analyze the efficacy of baricitinib in...

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Published in:	Journal of the American Geriatrics Society (JAGS) Vol. 69; no. 10; pp. 2752 - 2758
Main Authors:	Abizanda, Pedro, Calbo Mayo, Juan María, Mas Romero, Marta, Cortés Zamora, Elisa Belén, Tabernero Sahuquillo, María Teresa, Romero Rizos, Luis, Sánchez‐Jurado, Pedro Manuel, Sánchez‐Nievas, Ginés, Campayo Escolano, Carlos, Ochoa Serrano, Alba, Sánchez‐Flor Alfaro, Victoria, López Bru, Rita, Gómez Ballesteros, Cristina, Caldevilla Bernardo, David, Callejas González, Francisco Javier, Andrés‐Pretel, Fernando, Lauschke, Volker Martin, Stebbing, Justin
Format:	Journal Article
Language:	English
Published:	Hoboken, USA John Wiley & Sons, Inc 01-10-2021 Wiley Subscription Services, Inc
Subjects:	Age Age Factors Aged Aged, 80 and over Antiviral Agents - administration & dosage Antiviral Agents - adverse effects Azetidines - administration & dosage Azetidines - adverse effects baricitinib Brief Report COVID-19 COVID-19 - mortality COVID-19 - physiopathology COVID-19 Drug Treatment COVID‐19‐Related Content Fatalities Female Hospital Mortality Humans Janus Kinase Inhibitors - administration & dosage Janus Kinase Inhibitors - adverse effects Male Medicin och hälsovetenskap Mortality older adults Older people Outcome and Process Assessment, Health Care Patients Pneumonia Pneumonia, Viral - diagnosis Pneumonia, Viral - drug therapy Purines - administration & dosage Purines - adverse effects Pyrazoles - administration & dosage Pyrazoles - adverse effects SARS-CoV-2 - isolation & purification Severity of Illness Index Spain - epidemiology Sulfonamides - administration & dosage Sulfonamides - adverse effects Spain COVID-19 baricitinib mortality older adults
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Summary:	Background Older adults are at the highest risk of severe disease and death due to COVID‐19. Randomized data have shown that baricitinib improves outcomes in these patients, but focused stratified analyses of geriatric cohorts are lacking. Our objective was to analyze the efficacy of baricitinib in older adults with COVID‐19 moderate‐to‐severe pneumonia. Methods This is a propensity score [PS]‐matched retrospective cohort study. Patients from the COVID‐AGE and Alba‐Score cohorts, hospitalized for moderate‐to‐severe COVID‐19 pneumonia, were categorized in two age brackets of age <70 years old (86 with baricitinib and 86 PS‐matched controls) or ≥70 years old (78 on baricitinib and 78 PS‐matched controls). Thirty‐day mortality rates were analyzed with Kaplan–Meier and Cox proportional hazard models. Results Mean age was 79.1 for those ≥70 years and 58.9 for those <70. Exactly 29.6% were female. Treatment with baricitinib resulted in a significant reduction in death from any cause by 48% in patients aged 70 or older, an 18.5% reduction in 30‐day absolute mortality risk (n/N: 16/78 [20.5%] baricitinib, 30/78 [38.5%] in PS‐matched controls, p < 0.001) and a lower 30‐day adjusted fatality rate (HR 0.21; 95% CI 0.09–0.47; p < 0.001). Beneficial effects on mortality were also observed in the age group <70 (8.1% reduction in 30‐day absolute mortality risk; HR 0.14; 95% CI 0.03–0.64; p = 0.011). Conclusions Baricitinib is associated with an absolute mortality risk reduction of 18.5% in adults older than 70 years hospitalized with COVID‐19 pneumonia.
Bibliography:	Funding information Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, Grant/Award Number: CB16/10/00408; Instituto de Salud Carlos III, Grant/Award Number: COV20/00004 Justin Stebbing and Volker Martin Lauschke contributed equally to the work. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 Funding information Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, Grant/Award Number: CB16/10/00408; Instituto de Salud Carlos III, Grant/Award Number: COV20/00004
ISSN:	0002-8614 1532-5415 1532-5415
DOI:	10.1111/jgs.17357