Baricitinib reduces deaths in hospitalized COVID-19 patients
The rheumatoid arthritis drug baricitinib was shown to reduce mortality in hospitalized COVID-19 patients, according to a randomized, controlled trial published in The Lancet Respiratory Medicine yesterday. Baricitinib acts as a Janus kinases inhibitor and is under emergency use authorization to treat severe COVID-19 by the US Food and Drug Administration.
The study, called COV-BARRIER, consisted of 1,525 hospitalized COVID-19 patients (median age, 57.6 years) from 12 countries who received either baricitinib daily for 14 days or placebo in addition to standard care, which could have included remdesivir or dexamethasone. Those in the intervention arm had lower mortality rates at 28 days (8% vs 13%)—which indicates that for every 20 patients treated 1 death is prevented—as well as at 60 days (10% vs 15%).
The treatment did not stop disease progression, however: 27.8% of baricitinib and 30.5% of placebo recipients had outcomes requiring ventilation or high-flow oxygen needs, or they died.
"When COVID hits your body and the train is leaving the station, we did not find that this medication stopped the progress of the disease process entirely," co-principal investigator E. Wesley Ely, MD, MPH, in a Vanderbilt University press release. "If you were already sick, you continued to get a little sicker. The train keeps going a little bit, but adding baricitinib keeps you from going over the cliff into death."
Overall, baricitinib was connected with hazard ratios of 0.57 for 28-day all-cause mortality (43% lower death rate) and 0.62 for 60-day all-cause mortality (38% lower). Serious adverse events, serious infections, and venous thromboembolic events were similar between both groups.
"Importantly, the COV-BARRIER study showed that the survival benefits provided by baricitinib were independent of the presence or absence of concomitant use of steroids (mostly dexamethasone)—ie, an absence of treatment interaction," notes Andre C. Kalil, MD, MPH, and Justin Stebbing, MD, PhD, in a related commentary.
Sep 1 Lancet Respir Med study and commentary
Sep 1 Vanderbilt University press release
Study shows minimal risk of Guillain-Barre relapse after COVID vaccine
Only 1 of 702 adults who previously had Guillain-Barre syndrome (GBS) needed medical care for a relapse after receiving the Pfizer/BioNTech COVID-19 vaccine, finds a study yesterday in JAMA Neurology.
Researchers at Maccabi Healthcare Services in Tel Aviv and Haifa, Israel, conducted the retrospective study to evaluate the country's policy of not excluding people previously diagnosed as having GBS from receiving the vaccine. An earlier association between other vaccines and GBS had raised concerns among clinicians and patients about COVID-19 vaccines.
After reviewing electronic health records in the Maccabi Healthcare Services database, the researchers identified 702 GBS patients, 579 of whom had received one Pfizer COVID-19 vaccine dose; 539 had received both doses. Mean patient age was 53 years.
Median follow-up was 108 days after the first dose and 90 days after the second. Among 40 patients who had received only one dose, 38 were previously diagnosed as having COVID-19 and didn't need the second dose, per Israeli Ministry of Health guidelines.
Among the 579 patients who had received at least one dose, 48 (8.3%) sought care at a hospital. Twenty-four of the 48 patients visited an emergency department for treatment of short-term nonneurologic problems and were released after less than 24 hours, and the rest were hospitalized.
Five patients were referred to a hospital for treatment of neurologic issues, 2 for paresthesia (burning, tingling, or itching), 1 who had experienced a tremor for several months, and 1 for evaluation after a seizure. All were released from the emergency department within several hours.
The fifth patient, who had a history of GBS, was hospitalized and given plasmapheresis (exchange of blood plasma) for treatment of peripheral nerve dysfunction and paresthesia a few days after the second vaccine dose. The patient experienced substantial improvement of lower limb weakness and was released.
"The Israeli Ministry of Health and national immunization guidelines did not include a history of GBS as a precaution or contraindication to receiving the COVID-19 vaccine, and our study supports this approach," the study authors concluded.
Sep 1 JAMA Neurol research letter
Chronic wasting disease detected in Wisconsin deer living on deer farms
A 1-year-old doe at a Wisconsin deer farm in Langlade County has tested positive for chronic wasting disease (CWD). The doe, along with 57 other deer at the 6-acre farm, were already under quarantine after the farm received deer from a CWD-infected farm, the Wisconsin Department of Agriculture, Trade and Consumer Protection (DATCP) said yesterday.
DATCP said the herd will remain under quarantine. Langlade County is in northeastern Wisconsin.
In August, Wisconsin game officials announced CWD detections at deer farms in Sauk and Taylor counties. Sauk County is in southern Wisconsin, near Madison, and Taylor County is in the north central part of the state, not far from Langlade.
On Aug 11, officials said "Positive samples were taken from a 6-year-old doe in Taylor County and a 9-year-old buck in Sauk County. There is no connection between the two locations."
The 227 whitetail deer at the 22-acre double-fenced Taylor County farm and the 2 whitetail deer at the 1-acre single-fenced Sauk County farm have been quarantined, the DATCP said.
CWD is a fatal prion disease that affects deer, elk, and other cervids, and has affected 26 US states and 3 Canadian provinces. No cases have yet been reported in people, but some experts fear that it could jump to humans and cause a disease similar to bovine spongiform encephalopathy (BSE, or "mad cow" disease).
Sep 1 DATCP bulletin
Aug 11 DATCP bulletin