tetano
Editor, Senior Moderator
Respir Investig
. 2023 Apr 18;61(4):438-444.
doi: 10.1016/j.resinv.2023.03.009. Online ahead of print. 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
Yasutaka Hirasawa[SUP] 1 [/SUP], Jiro Terada[SUP] 2 [/SUP], Yu Shionoya[SUP] 2 [/SUP], Atsushi Fujikawa[SUP] 2 [/SUP], Yuri Isaka[SUP] 3 [/SUP], Yuichiro Takeshita[SUP] 2 [/SUP], Toru Kinouchi[SUP] 3 [/SUP], Ken Koshikawa[SUP] 2 [/SUP], Hiroshi Tajima[SUP] 2 [/SUP], Taku Kinoshita[SUP] 2 [/SUP], Yuji Tada[SUP] 2 [/SUP], Koichiro Tatsumi[SUP] 3 [/SUP], Kenji Tsushima[SUP] 4 [/SUP]
Affiliations
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Keywords: COVID-19; Dexamethasone; Pneumonia; Predicted body weight.
. 2023 Apr 18;61(4):438-444.
doi: 10.1016/j.resinv.2023.03.009. Online ahead of print. 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
Yasutaka Hirasawa[SUP] 1 [/SUP], Jiro Terada[SUP] 2 [/SUP], Yu Shionoya[SUP] 2 [/SUP], Atsushi Fujikawa[SUP] 2 [/SUP], Yuri Isaka[SUP] 3 [/SUP], Yuichiro Takeshita[SUP] 2 [/SUP], Toru Kinouchi[SUP] 3 [/SUP], Ken Koshikawa[SUP] 2 [/SUP], Hiroshi Tajima[SUP] 2 [/SUP], Taku Kinoshita[SUP] 2 [/SUP], Yuji Tada[SUP] 2 [/SUP], Koichiro Tatsumi[SUP] 3 [/SUP], Kenji Tsushima[SUP] 4 [/SUP]
Affiliations
- PMID: 37119744
- PMCID: PMC10110979
- DOI: 10.1016/j.resinv.2023.03.009
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Keywords: COVID-19; Dexamethasone; Pneumonia; Predicted body weight.