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Original article
DOI: 10.1016/j.reuma.2020.10.009
Available online 23 December 2020
Experience With the Use of Baricitinib and Tocilizumab Monotherapy or Combined, in Patients With Interstitial Pneumonia Secondary to Coronavirus COVID19: A Real-World Study
Experiencia con el uso de baricitinib y tocilizumab en monoterapia o combinados, en pacientes con neumonía intersticial secundaria al coronavirus COVID-19: Un estudio del mundo real
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José Rosasa,
Corresponding author
j.rosas.gs@gmail.com

Corresponding author.
, Francisco Pasquau Liañob, Mónica Llombart Cantóc, José María Carrasco Baread, Amparo Raga Besere, José Tomás Algado Rabasab, Francisco Martínez Adsuarf, Brian Vila Aulic, Isabel Fernández Lópezd, Ana María Garijo Sainzb, Pere Esquerdo Ramisb, Laura Ruiz Pérezd, Mª Luisa Navarrete Rebollod, Raquel Hernández Loridog, Laura Gómez Escolarh, COVID19-HMB Group
a Rheumatology Department, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
b Internal Medicine Department, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
c Pneumology Department, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
d Intensive Care Department, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
e Pharmacy Department, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
f Anesthesia Department, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
g Neurology Department, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
h Gastroenterology Department, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
Received 22 July 2020. Accepted 28 October 2020
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Figures (2)
Tables (2)
Table 1. Characteristics of patients admitted for COVID 19, according to treatment received: (1) BARI monotherapy. (2) TCZ monotherapy. (3) The patients have received BARI and TCZ. (4) Patients not treated with either BARI or TCZ.
Table 2. ICU admission, mortality, PaO2/FiO2 and anticytokine drugs received in patients admitted with interstitial pneumonia.
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Abstract
Objective

To describe the experience of treatment with baricitinib (BARI) and/or tocilizumab (TCZ), in monotherapy or combined, in patients admitted for interstitial pneumonia secondary to COVID19, and for 30 days after discharge.

Methods

Medical records of patients admitted with COVID19 and IP with PaO2/FiO2<300, treated with BARI and/or TCZ, and compared with patients who did not, were retrospectively reviewed.

Results

Sixty patients were included; 43 (72%) are males, mean age 67 (SD: 14) years (<50 years: 17%; 51–70: 30%; >70: 53%), with 8.5 (SD: 1) days of symptoms. Sixteen (27%) patients required ICU (94% in <70 years). Fifteen (25%) patients died, 67% in >70 years; 11 (18%) patients died in the first 15 days of admission and 4 (7%) between days 16 to 30. Twenty-three (38%) patients received BARI, 12 (52%) monotherapy (Group 1), during 6 (SD: 2.6) days on average, none required ICU and 2 (17%) died. Thirty-one (52%) patients received TCZ, 20 (33%) as monotherapy (Group 2), 16 (52%) patients required ICU and 4 (20%) died. In the 11 (18%) patients who received BARI (2.8 [SD: 2.5] days average) and TCZ combined (Group 3), 3 (27%) required ICU and died. There were no severe side effects in BARI or TCZ patients. In the 17 (28%) patients who received neither BARI nor TCZ (Group 4), none required ICU and 6 (35%) died. Mean (SD) PaO2/FiO2 at admission between groups was respectively: 167 (82.3), 221 (114.9), 236 (82.3), 276 (83.2).

Conclusion

Treatment with BARI and TCZ did not cause serious side effects. They could be considered early in patients with NI secondary to COVID19 and impaired PaO2/PaFi.

Keywords:
COVID19
Baricitinib
Tocilizumab
Interstitial pneumonia
ICU
Resumen
Objetivo

Describir la experiencia con baricitinib (BARI) y/o tocilizumab (TCZ), en monoterapia o combinados en pacientes ingresados por neumonía intersticial (NI) por COVID-19 y durante los 30 días después del alta.

Método

Se revisaron retrospectivamente las historias clínicas de los pacientes ingresados por COVID-19 y NI, con PaO2/FiO2<300, tratados con BARI y/o TCZ y se compararon con pacientes que no los recibieron.

Resultados

Se incluyeron 60 pacientes; 43 (72%) varones, edad media 67 (DE: 14) años (< 50 años: 17%; 51-70: 30%; > 70: 53%), y 8,5 (DE: 1) días de síntomas. Dieciséis (27%) ingresaron en la unidad de cuidados intensivos (UCI) (94% < 70 años). Quince (25%) fallecieron (67% > 70 años); 11 (18%) de ellos en los primeros 15 días del ingreso y cuatro (7%) entre los días 16 y 30. Veintitrés (38%) pacientes recibieron BARI, 12 (52%) en monoterapia (Grupo 1), durante seis (DE: 2.6) días de promedio, ninguno de ellos ingresó en UCI y dos (17%) fallecieron. Treinta y un (52%) pacientes recibieron una dosis de TCZ, 20 (33%) en monoterapia (Grupo 2), 16 (52%) ingresaron en UCI y cuatro (20%) fallecieron. Entre los 11 (18%) pacientes que recibieron BARI (2,8 [DE: 2,5] días de promedio) y TCZ combinados (Grupo 3), tres (27%) ingresaron en UCI y fallecieron. No hubo efectos secundarios graves entre los que recibieron BARI y/o TCZ. Entre los 17 (28%) pacientes que no recibieron ni BARI ni TCZ (Grupo 4), ninguno ingresó en UCI y seis (35%) fallecieron. La PaO2/FiO2 media (DE) al ingreso entre los grupos fue respectivamente: 167 (82,3), 221 (114,9), 236 (82,3), 276 (83,2).

Conclusión

El tratamiento con BARI y TCZ no provocó efectos secundarios graves. Podrían considerarse precozmente en pacientes con NI secundaria a COVID-19 y deterioro de PaO2/PaFi.

Palabras clave:
COVID-19
Baricitinib
Tocilizumab
Neumonía intersticial
UCI

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