Baricitinib Therapy in Covid-19 Pneumonia Save

The NEJM has published the results of the ACCT-2 Study,  a double-blind, randomized, placebo-controlled trial evaluating baricitinib, an inhibitor of Janus kinase 1 (JAK1) and JAK2, plus remdesivir in hospitalized adults with Covid-19. The primary outcome was the time to recovery. The key secondary outcome was clinical status at day 15.

The study enrolled 1033 patients given either remdesivir with either baricitinib (combination group) or placebo (control group). Remdesivir was was given as 200 mg IV on day 1, then daily through day 10 or until hospital discharge or death. Baricitinib 4 mg daily for up to 14 days (renal dose adjustments were allowed).

Overall, the time to recovery was significantly less in the combination group than in the control group (median, 7 vs. 8 days;  P=0.03). The combination group also had a 30% higher odds of improvement at day 15 and a lower risk of serious adverse events (16.0% vs. 21.0%).

These findings confirm the results of an earlier open-label study showing the beneficial effects of baricitinib in Covid-19 and suggests that remdesivir may be most effective if given early. Baricitinib has benefits by blocking immune driven inflammation and inhibiting viral replication.