PDF(Pubmed)
Abstract：
Hyperinflammatory Coronavirus disease 2019 (COVID-19) and rapidly-progressive interstitial lung diseases (RP-ILD) secondary to inflammatory myopathies (IIM) present important similarities. These data support the use of anti-rheumatic drugs for the treatment of COVID-19. The aim of this study was to compare the efficacy of combining baricitinib and pulse steroids with the Standard of Care (SoC) for the treatment of critically ill COVID-19 patients. We retrospectively enrolled consecutive patients admitted to the Intensive Care Unit (ICU) with COVID-19-pneumonia. Patients treated with SoC (dexamethasone plus remdesivir) were compared to patients treated with baricitinib plus 6-methylprednisolone pulses (Rheuma-group). We enrolled 246 patients: 104/246 in the SoC and 142/246 in the Rheuma-group. All patients presented laboratory findings suggestive of hyperinflammatory response. Sixty-four patients (26.1%) died during ICU hospitalization. The mortality rate in the Rheuma-group was significantly lower than in the SoC-group (15.5 vs. 40.4%, p < 0.001). Compared to the SoC-group, patients in the Rheuma-group presented significantly lower inflammatory biomarker levels after one week of treatment. Higher ferritin levels after one week of treatment were strongly associated with mortality (p < 0.001). In this large real-life COVID-19 cohort, baricitinib and pulse steroids led to a significant reduction in mortality, paralleled by a prompt reduction in inflammatory biomarkers. Our experience supports the similarities between hyperinflammatory COVID-19 and the IIM-associated RP-ILD.
摘要：
2019年高炎性冠状病毒病（COVID-19）和继发于炎性肌病（IIM）的快速进展性间质性肺病（RP-ILD）具有重要的相似性。这些数据支持使用抗风湿药治疗COVID-19。这项研究的目的是比较巴利替尼和脉冲类固醇与标准护理（SoC）联合治疗重症COVID-19患者的疗效。我们回顾性纳入重症监护病房（ICU）收治的COVID-19肺炎连续患者。将接受SoC（地塞米松加雷德西韦）治疗的患者与接受baricitinib加6-甲基强的松龙脉冲治疗的患者（Rheuma组）进行比较。我们招募了246名患者：SoC组104/246，Rheuma组142/246。所有患者的实验室检查结果提示炎症反应过度。64例（26.1%）在ICU住院期间死亡。Rheuma组的死亡率显着低于SoC组（15.5vs.40.4%,p<0.001)。与SoC组相比，治疗1周后,Rheuma组患者的炎性生物标志物水平显著降低.治疗一周后较高的铁蛋白水平与死亡率密切相关(p<0.001)。在这个大型现实生活中的COVID-19队列中，baricitinib和脉冲类固醇导致死亡率显着降低，同时炎症生物标志物的迅速减少。我们的经验支持高炎性COVID-19和IIM相关的RP-ILD之间的相似性。
