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Baricitinib, a janus kinases inhibitor, can potentially suppress inflammatory cascades in severe COVID-19 pneumonia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The objective of this study was to compare the clinical outcomes of high dose of baricitinib with its usual dose in patients with severe COVID-19 pneumonia. This prospective cohort study was conducted on 238 adult patients with severe COVID-19 pneumonia. Eight milligram and 4\u2009mg of baricitinib was given orally to 122 patients in the high dose (HD) group and 116 patients the usual dose (UD) group, respectively daily for 14\u2009days, and clinical outcomes were compared among the groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Blood oxygen saturation level was stabilized (\u226594% on room air) earlier in the HD group compared to the UD group [5 (IQR: 4\u20135)\/8 (IQR: 6\u20139),<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05]. Patients in the HD group required intensive care unit (ICU) and intubation supports more in the UD group than that in patients of the HD group [17.2%\/9%,<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05; 11.2%\/4.1%,<jats:italic>P<\/jats:italic>\u2009&gt;\u20090.05;<jats:italic>N<\/jats:italic>\u2009=\u2009116\/122, respectively]. The 30-day mortality and 60-day rehospitalization rate were higher in the UD group than the HD group [6%\/3.3%,<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01; 11.9%\/7.6%,<jats:italic>P<\/jats:italic>\u2009&gt;\u20090.05;<jats:italic>N<\/jats:italic>\u2009=\u2009116\/122, respectively].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The daily high dose of baricitinib in severe COVID-19 results in early stabilization of the respiratory functions, declined requirements of critical care supports, reduced rehospitalization with mortality rate compared to its daily usual dose.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12879-021-06119-2","type":"journal-article","created":{"date-parts":[[2021,5,7]],"date-time":"2021-05-07T07:03:10Z","timestamp":1620370990000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Impact of high dose of baricitinib in severe COVID-19 pneumonia: a prospective cohort study in Bangladesh"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7038-6437","authenticated-orcid":false,"given":"Md. 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