Comparative Efficacy of Tocilizumab and Baricitinib Administration in COVID-19 Treatment: A Retrospective Cohort Study

  1. Yuichi Kojima
  2. Sho Nakakubo
  3. Nozomu Takei
  4. Keisuke Kamada
  5. Yu Yamashita
  6. Junichi Nakamura
  7. Munehiro Matsumoto
  8. Hiroshi Horii
  9. Kazuki Sato
  10. Hideki Shima
  11. Masaru Suzuki
  12. Satoshi Konno

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Abstract

Background and Objectives: Tocilizumab and baricitinib have been observed to improve the outcomes of patients with coronavirus disease 2019 (COVID-19). However, a comparative evaluation of these drugs has not been performed. Materials and Methods: A retrospective, single-center study was conducted using the data of COVID-19 patients admitted to Hokkaido University hospital between April 2020 and September 2021, who were treated with tocilizumab or baricitinib. The clinical characteristics of the patients who received tocilizumab were compared to those of patients who received baricitinib. Univariate and multivariate logistic regression analyses of the outcomes of all-cause mortality and improvement in respiratory status were performed. The development of secondary infection events was analyzed using the Kaplan–Meier method and the log-rank test. Results: Of the 459 patients hospitalized with COVID-19 during the study, 64 received tocilizumab treatment and 34 baricitinib treatment, and those 98 patients were included in the study. Most patients were treated with concomitant steroids and exhibited the same severity level at the initiation of drug treatment. When compared to each other, neither tocilizumab nor baricitinib use were associated with all-cause mortality or improvement in respiratory status within 28 days from drug administration. Conclusions: Age, chronic renal disease and early administration of TCZ or BRT from the onset of COVID-19 were independent prognostic factors for all-cause mortality, whereas anti-viral drug use and the severity of COVID-19 at baseline were associated with an improvement in respiratory status. Secondary infection-free survival rates of patients treated with tocilizumab and those treated with baricitinib did not significantly differ. The results suggest that both tocilizumab and baricitinib could be clinically equivalent agents of choice in treatment of COVID-19.

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  1. Version published to 10.3390/medicina58040513
  2. ScreenIT

    SciScore for 10.1101/2021.12.13.21267717: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: The requirement for obtaining informed consent was waived by the relevant ethics committee due to the retrospective nature of the study.
    IRB: The requirement for obtaining informed consent was waived by the relevant ethics committee due to the retrospective nature of the study.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All P-values were two-tailed, with statistical significance set at P < 0.05. JMP (SAS Institute Inc., Cary, NC, USA) were used for all statistical processing.
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has several limitations. First, since the study was retrospective, prospective validation is needed to show the comparative efficacy of TCZ and BRT. Second, variant strains of SARS-CoV-2 and changes in healthcare availability that may affect patient outcomes were not validated in this study due to lack of data. Lastly, the efficacy of using the biological agents as a standalone treatment for COVID-19 was not verified in this study. However, the efficacy of TCZ and BRT has already been proven in previous studies. Our study was conducted to suggest a more favorable treatment based on these evidence-based practices of using TCZ and BRT. In conclusion, the use of TCZ versus BRT had no different impact on all-cause mortality, improvement in respiratory status, and the development of secondary infection in patients diagnosed with COVID-19. In light of our findings, both biological agents are expected to be equally safe and clinically effective, although future prospective studies are needed.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.12.13.21267717 on medRxiv