ABSTRACT
Baricitinib and imatinib are considered therapies for coronavirus disease 2019 (COVID-19), but their ultimate clinical impact remains to be elucidated, so our objective is to determine whether these kinase inhibitors provide benefit when added to standard care in hospitalized COVID-19 patients. Phase-2, open-label, randomized trial with a pick-the-winner design conducted from September 2020 to June 2021 in a single Spanish center. Hospitalized adults with COVID-19 pneumonia and a symptom duration ≤10 days were assigned to 3 arms: imatinib (400 mg qd, 7 days) plus standard-care, baricitinib (4 mg qd, 7 days) plus standard-care, or standard-care alone. Primary outcome was time to clinical improvement (discharge alive or a reduction of 2 points in an ordinal scale of clinical status) compared on a day-by-day basis to identify differences ≥15% between the most and least favorable groups. Secondary outcomes included oxygenation and ventilatory support requirements, additional therapies administered, all-cause mortality, and safety. One hundred and sixty-five patients analyzed. Predefined criteria for selection of the most advantageous arm were met for baricitinib, but not for imatinib. However, no statistically significant differences were observed in formal analysis, but a trend toward better results in patients receiving baricitinib was found compared to standard care alone (hazard ratio [HR] for clinical improvement: 1.41, 95% confidence intervals [CI]: 0.96-2.06; HR for discontinuing oxygen: 1.46, 95% CI: 0.94-2.28). No differences were found regarding additional therapies administered or safety. Baricitinib plus standard care showed better results for hospitalized COVID-19 patients, being the most advantageous therapeutic strategy among those proposed in this exploratory clinical trial.
Subject(s)
COVID-19 , Adult , Humans , Imatinib Mesylate , SARS-CoV-2 , COVID-19 Drug Treatment , Treatment OutcomeSubject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/drug therapy , Imatinib Mesylate/therapeutic use , Lung/drug effects , Pneumonia, Viral/drug therapy , Protein Kinase Inhibitors/therapeutic use , Adult , Biomarkers/blood , C-Reactive Protein/metabolism , COVID-19 , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/pathology , Coronavirus Infections/virology , Drug Combinations , Female , Humans , Hydroxychloroquine/administration & dosage , Lopinavir/administration & dosage , Lung/diagnostic imaging , Lung/pathology , Lung/virology , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , Ritonavir/administration & dosage , SARS-CoV-2 , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , HIV Infections/complications , Neoplasms/classification , Neoplasms/complications , Epidemiology, Descriptive , Risk Factors , Follow-Up Studies , Spain/epidemiologySubject(s)
Brain Diseases/etiology , HIV Infections/complications , Hematoma/etiology , Leukoencephalopathy, Progressive Multifocal/etiology , Adult , Antiretroviral Therapy, Highly Active , Brain Diseases/pathology , Brain Diseases/virology , DNA, Viral/analysis , Disease Progression , Fatal Outcome , Hematoma/pathology , Hematoma/virology , Hepatitis C, Chronic/complications , Humans , Intracranial Pressure , JC Virus/isolation & purification , JC Virus/pathogenicity , Magnetic Resonance Imaging , Male , Seizures/drug therapy , Seizures/etiologyABSTRACT
No disponible