Covid-19 living Data

Pharmacologic treatments for covid-19 patients

Baricitinib vs Standard care/Placebo

This comparison will not be updated. Last search date 14 Dec, 2022

Hospitalized patients

Forest plots
(last update: 2022-10-07)

Summary of findings
(last update: 2022-10-13)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Baricitinib
Comparison: Standard care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 1.02 (1.00 - 1.05)	16 more per 1000 (from 0 fewer to 39 more)		High certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Not serious
3 trials Macroni V, 2021; Horby P, 2022; Ely EW, 2022 9782 participants		Baricitinib 792 per 1,000 (777 - 816)	Standard care/Placebo 777 per 1,000
Clinical improvement D60	RR: 1.04 (0.91 - 1.18)	30 more per 1000 (from 68 fewer to 136 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Multicentre study conducted across several countries, therefore not downgraded for indirectness Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Troseid M, 2022 284 participants		Baricitinib 784 per 1,000 (686 - 889)	Standard care/Placebo 754 per 1,000
WHO progression score (level 7 or above) D28	RR: 0.81 (0.68 - 0.97)	38 fewer per 1000 (from 64 fewer to 6 fewer)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
3 trials Macroni V, 2021; Ely EW, 2022; Troseid M, 2022 1910 participants		Baricitinib 162 per 1,000 (136 - 194)	Standard care/Placebo 200 per 1,000
WHO progression score (level 7 or above) D60	Outcome not yet measured or reported
All-cause mortality D28	RR: 0.76 (0.60 - 0.96)	34 fewer per 1000 (from 56 fewer to 6 fewer)		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Serious Inconsistency downgraded by 1 level: I²=:55.1% Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
4 trials Macroni V, 2021; Horby P, 2022; Ely EW, 2022; Troseid M, 2022 10066 participants		Baricitinib 106 per 1,000 (84 - 134)	Standard care/Placebo 140 per 1,000
All-cause mortality D60	RR: 0.73 (0.59 - 0.89)	48 fewer per 1000 (from 73 fewer to 20 fewer)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
3 trials Macroni V, 2021; Ely EW, 2022; Troseid M, 2022 1910 participants		Baricitinib 129 per 1,000 (105 - 158)	Standard care/Placebo 177 per 1,000
Viral negative conversion D7	Outcome not yet measured or reported
Adverse events	RR: 0.96 (0.88 - 1.05)	19 fewer per 1000 (from 56 fewer to 23 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
2 trials Macroni V, 2021; Ely EW, 2022 1626 participants		Baricitinib 451 per 1,000 (413 - 493)	Standard care/Placebo 470 per 1,000
Serious adverse events	RR: 0.80 (0.67 - 0.95)	43 fewer per 1000 (from 71 fewer to 11 fewer)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to low number of participants/events
3 trials Macroni V, 2021; Ely EW, 2021; Troseid M, 2022 1910 participants		Baricitinib 171 per 1,000 (143 - 203)	Standard care/Placebo 214 per 1,000

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

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Permanent URL for this comparison: https://covid-nma.com/living_data/index.php?comparison=382

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Trial	Funding	Comparisons		Design	Participants	Sample size	Overall risk of bias Highest assessment	Full description
		Treatment 1	Treatment 2
NCT04891133; EudraCT 2021-000541-41; EU CTIS 2022-500385-99-00 Bari-SolidAct Troseid M, SSRN, 2022 Full text Commentary Commentary	Mixed	Baricitinib	Placebo	RCT	Patients with confirmed COVID-19 (severe-critical) admitted to 39 centers in Austria, Belgium, France, Ireland, Italy, Luxembourg, Norway, Portugal and Spain.	N=284	Some concerns Details	Full description
NCT04381936; EudraCT2020-001113-21; ISRCTN50189673 RECOVERY Horby P, Lancet, 2022 b Full text Full text Commentary Commentary Commentary	Public/non profit	Baricitinib	Standard care	RCT	Patients with suspected or confirmed COVID-19 (mild-critical) admitted to 159 centers in the UK.	N=8156	Some concerns Details	Full description
NCT04421027 COV-BARRIER Ely EW, Lancet Respir Med, 2022 Full text Full text Commentary Commentary Commentary	Private	Baricitinib	Placebo	RCT	Patients with confirmed COVID-19 (critical) admitted to 18 centers in Argentina, Brazil, Mexico and USA.	N=101	Low Details	Full description
NCT04421027 COV-BARRIER Marconi V, Lancet Respir Med, 2021 Full text Full text Full text Commentary Commentary	Private	Baricitinib	Placebo	RCT	Patients with confirmed COVID-19 (mild-moderate-severe) admitted to 101 centers in Argentina, Brazil, Germany, India, Italy, Japan, Mexico, Russia, South Korea, Spain, UK, USA	N=1525	Some concerns Details	Full description