Baricitinib Versus Tocilizumab for the Treatment of Moderate to Severe COVID-19

Background: To date, minimal data directly compare tocilizumab with baricitinib for treatment in moderate to severe COVID-19. Objective: To compare the rates of in-hospital mortality with progression to mechanical ventilation in patients with COVID-19 who received either tocilizumab or baricitinib. Methods: The authors conducted a single-centered, institutional review board-approved, retrospective cohort study. Patients who were 18 years or older who were hospitalized with COVID-19 and who received tocilizumab or baricitinib were included. The primary end point is a composite outcome of progression to mechanical ventilation or in-hospital mortality. Secondary end points include components of the composite outcome and progression to higher level of care, duration of mechanical ventilation, and hospital and intensive care length of stay. Safety end points include the incidence of infections and thrombosis. Results: A total of 176 patients were included, of whom 61 (34.7%) received tocilizumab and 115 (65.3%) received baricitinib. In the primary outcome, there was no difference between the groups (52.5% tocilizumab vs 44.3% baricitinib, P = 0.305). For safety outcomes, there was a higher instance of thrombosis (11.5% tocilizumab vs 3.5% baricitinib, P = 0.042) and rates of antibiotic use after initiation of therapy (55.7% tocilizumab vs 38.3% baricitinib, P = 0.026) in the tocilizumab group. Conclusion and Relevance: There was no significant difference in the composite outcome in patients who received tocilizumab or baricitinib for the treatment of COVID-19. However, there was an increase in rates of thrombosis in those receiving tocilizumab compared with baricitinib. These results need to be confirmed in larger prospective, randomized trials.