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Covid study shows arthritis drug can help patients recover

Adding an arthritis drug called baricitinib to Covid treatment regimens including remdesivir, an antiviral drug, could reduce recovery times by a day or more, especially for people with severe severity, according to a study published Friday. sick.

The results of a government-sponsored clinical trial were made public more than three weeks after the Food and Drug Administration issued an emergency use authorization for the dual treatment. Earlier this month, some experts said they were uncomfortable rolling out drugs without the ability to verify the underlying data supporting their performance. Last month, the World Health Organization also recommended against using remdesivir as a treatment for patients with Covid, as evidence to support its use was lacking.

Limited results were announced earlier in press releases, showing that hospitalized Covid patients treated with baricitinib and remdesivir recovered a day faster than those who received remdesivir alone.

Some questioned the adoption of the combination treatment given the high price of baricitinib – which could be around $ 1,500 per patient – and also cited side effects such as blood clots. Several doctors have also questioned whether adding baricitinib was worth it because steroids like dexamethasone were cheap and widely available. Baricitinib and dexamethasone are thought to work by reducing excessive inflammation, which leads to many severe cases of Covid.

The new article, published in the New England Journal of Medicine, adds some granularity to the results, showing that some patient subgroups benefited from the addition of baricitinib much more than others. The trial recruited more than 1,000 hospitalized patients with Covid, all of whom received remdesivir. People who were sick enough to require a high dose of supplemental oxygen or a non-invasive form of ventilation recovered eight days faster when baricitinib was included in their drug regimen.

In these groups, “I think the data clearly support the role of baricitinib,” said Dr Boghuma Kabisen Titanji, an infectious disease physician at Emory University who pioneered the first studies of baricitinib against coronavirus.

Dr Titanji also noted that the data suggested that some patients may be less likely to die or need a ventilator if they take baricitinib in addition to remdesivir. But these results, like the results that showed faster recovery times, were not consistent among trial participants.

Dr Lauren Henderson, a pediatric rheumatologist at Boston Children’s Hospital, said she was encouraged by the results and the prospect of having another option in the coronavirus treatment arsenal.

But she and several other experts added that they may still be inclined to abandon dexamethasone as a treatment for critically ill Covid-19 patients who need respiratory assistance.

Dexamethasone, unlike baricitinib, has been shown in studies to reduce mortality in critically ill Covid patients. It is also inexpensive and easy to obtain, while baricitinib is seen more as a specialty drug, which could pose supply chain barriers, said Dr Erin McCreary, infectious disease pharmacist at the ‘University of Pittsburgh.

Several experts pointed to another National Institutes of Health trial that will conduct a direct comparison of two combined treatment regimens: one that puts hospital patients on remdesivir and baricitinib, and another that combines remdesivir with dexamethasone. Dr. McCreary also stressed the importance of studying patients who receive both baricitinib and dexamethasone “to determine if there is an additional benefit”.

Dr Andre Kalil, an infectious disease physician at the University of Nebraska Medical Center and principal investigator of the new document, noted that while dexamethasone had already become a widely accepted treatment for Covid-19, the steroid still needed study. further. He cited “a host of serious safety concerns” with the drug that deserved careful consideration.

Like other steroids, dexamethasone, which largely eases inflammation, can cause a host of unwanted side effects, including aggravating conditions like diabetes or osteoporosis.

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