The National Institutes of Health has updated its COVID-19 Treatment Guidelines with new information following the FDA emergency use authorization of baricitinib.
Baricitinib was recently authorized in combination with remdesivir in hospitalized adults and children aged ≥2 years with COVID-19 who require supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation.
A recent article in the NEJM found administering the drug in combination with remdesivir improved time to recovery (10 days vs 18 days control) in patients receiving high-flow oxygen or noninvasive ventilation.
According to an NIH statement, after reviewing the available evidence for baricitinib, the NIH’s COVID-19 Treatment Guidelines Panel determined the following:
- There are insufficient data for the Panel to recommend either for or against the use of baricitinib in combination with remdesivir for the treatment of COVID-19 in hospitalized patients in cases where corticosteroids can be used instead.
- In the rare circumstances where corticosteroids cannot be used, the Panel recommends using baricitinib in combination with remdesivir for the treatment of COVID-19 in hospitalized, nonintubated patients who require oxygen supplementation (BIIa).
- The Panel recommends against the use of baricitinib in the absence of remdesivir, except in a clinical trial (AIII).
- There are insufficient data for the Panel to recommend either for or against the use of baricitinib in combination with corticosteroids for the treatment of COVID-19. Since both agents are potent immunosuppressants, there is potential for an additive risk of infection.
- More data are needed to clarify the role of baricitinib in the management of COVID-19. Healthcare providers are encouraged to discuss participation in baricitinib clinical trials with their patients.