Combination therapy with predicted body weight-based dexamethasone, remdesivir, and baricitinib in patients with COVID-19 pneumonia: A single-center retrospective cohort study during 5th wave in Japan

• Published in: Respiratory investigation 2023-07, Vol.61 (4), p.438-444
• Main Authors: Hirasawa, Yasutaka, Terada, Jiro, Shionoya, Yu, Fujikawa, Atsushi, Isaka, Yuri, Takeshita, Yuichiro, Kinouchi, Toru, Koshikawa, Ken, Tajima, Hiroshi, Kinoshita, Taku, Tada, Yuji, Tatsumi, Koichiro, Tsushima, Kenji
• Format: Article
• Language: English
• Subjects: COVID-19; Dexamethasone; Original; Pneumonia; Predicted body weight
• ISSN: 2212-5345; 2212-5353
• DOI: 10.1016/j.resinv.2023.03.009

Dexamethasone, remdesivir, and baricitinib reduce mortality in patients with coronavirus disease 2019 (COVID-19). A single-arm study using combination therapy with all three drugs reported low mortality in patients with severe COVID-19. In this clinical setting, whether dexamethasone administered as a fixed dose of 6 mg has sufficient inflammatory modulation effects of reducing lung injury has been debated. This single-center retrospective study was conducted to compare the treatment strategies/management in different time periods. A total of 152 patients admitted with COVID-19 pneumonia who required oxygen therapy were included in this study. A predicted body weight (PBW)-based dose of dexamethasone with remdesivir and baricitinib was administered between May and June 2021. After this period, patients were administered a fixed dose of dexamethasone at 6.6 mg/day between July and August 2021. The additional respiratory support frequency of high-flow nasal cannula, noninvasive ventilation, and mechanical ventilation was analyzed. Moreover, the Kaplan–Meier method was used to analyze the duration of oxygen therapy and the 30-day discharge alive rate, and they were compared using the log-rank test. Intervention and prognostic comparisons were performed in 64 patients with PBW-based and 88 with fixed-dose groups. The frequency of infection or additional respiratory support did not differ statistically. The cumulative incidence of being discharged alive or oxygen-free rate within 30 days did not differ between the groups. In patients with COVID-19 pneumonia who required oxygen therapy, combination therapy with PBW-based dexamethasone, remdesivir, and baricitinib might not shorten the hospital stay's length or oxygen therapy's duration.