{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T06:32:01Z","timestamp":1775111521648,"version":"3.50.1"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T00:00:00Z","timestamp":1692835200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The immunomodulators tocilizumab and baricitinib improve outcomes in severely ill patients with coronavirus disease 2019 (COVID\u201019); however, comparative analyses of clinical outcomes related to these agents are lacking. A tocilizumab national shortage shifted treatment to baricitinib in critically ill patients, allowing for an outcome comparison in a similar population. The purpose of this study is to compare clinical outcomes in critically ill COVID\u201019 patients who received tocilizumab and those who received baricitinib.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective, observational cohort study using generalized estimating equation models, accounting for clustering by hospital and known confounders, to estimate the proportional odds of the ordinal World Health Organization Clinical Progression Scale (WHO\u2010CPS) score at day 14, the primary outcome. Secondary outcomes included WHO\u2010CPS score at day 7.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Multiple hospitals within the Cleveland Clinic Health System.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>Adult patients admitted for COVID\u201019 between January 2021 and November 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>Receipt of tocilizumab, before its shortage, or baricitinib, during shortage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>In total, 507 patients were included; 217 received tocilizumab and 290 received baricitinib. Over 96% of patients required ICU admission and 98% received concomitant dexamethasone. Tocilizumab recipients had higher (worse) baseline WHO\u2010CPS scores. After adjustment, tocilizumab use was associated with higher odds of a worse day 14 WHO\u2010CPS score compared with baricitinib (adjusted odds ratio [OR] 1.65 [95% confidence interval (CI) 1.10\u20132.48]). Similarly, after adjustment, tocilizumab use was associated with higher odds of a worse day 7 WHO\u2010CPS score (adjusted OR 1.65 [95% CI 1.22\u20132.24]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Baricitinib use was associated with better WHO\u2010CPS scores at day 14 and day 7 compared with tocilizumab in a cohort of critically ill patients with COVID\u201019. The odds of having a one unit increase in WHO\u2010CPS score at day 14 was 71% higher with tocilizumab than baricitinib. No difference in mortality or adverse effects was noted.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2867","type":"journal-article","created":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T01:26:48Z","timestamp":1692408408000},"page":"28-38","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Baricitinib versus tocilizumab in critically ill <scp>COVID<\/scp>\u201019 patients: A retrospective cohort study"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7667-7347","authenticated-orcid":false,"given":"Grace M.","family":"Conroy","sequence":"first","affiliation":[{"name":"Department of Pharmacy Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0420-0320","authenticated-orcid":false,"given":"Seth R.","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea M.","family":"Pallotta","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4220-2359","authenticated-orcid":false,"given":"Abhijit","family":"Duggal","sequence":"additional","affiliation":[{"name":"Respiratory Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0070-8100","authenticated-orcid":false,"given":"Gretchen L.","family":"Sacha","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,8,24]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Coronavirus Disease (COVID\u201019) Treatment Guidelines.National Institutes of Health.2019. 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