#Baricitinib reduces 30-day mortality in older adults with moderate-to-severe #COVID-19 pneumonia

Older adults are at the highest risk of severe disease and death due to COVID-19. Randomized data have shown that baricitinib improves outcomes in these patients, but focused stratified analyses of geriatric cohorts are lacking. Our objective was to analyze the efficacy of baricitinib in older adults with COVID-19 moderate-to-severe pneumonia.

Methods
This is a propensity score [PS]-matched retrospective cohort study. Patients from the COVID-AGE and Alba-Score cohorts, hospitalized for moderate-to-severe COVID-19 pneumonia, were categorized in two age brackets of age <70 years old (86 with baricitinib and 86 PS-matched controls) or ≥70 years old (78 on baricitinib and 78 PS-matched controls). Thirty-day mortality rates were analyzed with Kaplan–Meier and Cox proportional hazard models.

Results
Mean age was 79.1 for those ≥70 years and 58.9 for those <70. Exactly 29.6% were female. Treatment with baricitinib resulted in a significant reduction in death from any cause by 48% in patients aged 70 or older, an 18.5% reduction in 30-day absolute mortality risk (n/N: 16/78 [20.5%] baricitinib, 30/78 [38.5%] in PS-matched controls, p < 0.001) and a lower 30-day adjusted fatality rate (HR 0.21; 95% CI 0.09–0.47; p < 0.001). Beneficial effects on mortality were also observed in the age group <70 (8.1% reduction in 30-day absolute mortality risk; HR 0.14; 95% CI 0.03–0.64; p = 0.011).

Conclusions
Baricitinib is associated with an absolute mortality risk reduction of 18.5% in adults older than 70 years hospitalized with COVID-19 pneumonia.

Key Points
Treatment with baricitinib results in a significant reduction (p < 0.001) in 30-day mortality from any cause in patients younger than 70 years by 54%, and by 48% in patients aged 70 or older.
Treatment with baricitinib is associated with an 8.1% reduction in 30-day absolute mortality risk in patients younger than 70, and with an 18.5% reduction in 30-day absolute mortality risk in those aged 70 or older.
Baricitinib is an effective treatment for older adults with moderate-to-severe COVID-19 pneumonia. Trials in this group are lacking.


Why Does this Paper Matter
Baricitinib is associated with a 30-day mortality reduction in adults older than 70 years hospitalized with COVID-19 pneumonia. Absolute risk reduction is higher in this population than in propensity score-matched young adults. Baricitinib could be an effective treatment for older adults

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