Effects and infection risks of baricitinib in combination with nirmatrelvir/ritonavir in elderly patients with severe or critical COVID-19: a retrospective observational cohort study.
4 affiliations
- 1Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, 100020, China.
- 2Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, 100020, China.
- 3Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, 100020, China. [email protected].
- 4Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongti South Road, Beijing, 100020, China. [email protected].
Abstract
Background
Baricitinib was shown to reduce the mortality of COVID-19 patients, but real world data about baricitinib in combination with nirmatrelvir/ritonavir for the treatment of elderly patients with severe or critical COVID-19 were limited. The aim of the study was to determine the effects and hospital-acquired infections occurrence after combined medication in these patients.Methods
We included severe or critical COVID-19 patients treated at Beijing Chaoyang Hospital from December 2022 to February 2023. We investigated duration of hospital stay, factors associated with reduced mortality risk, IL-6 levels and the characteristics of hospital-acquired infections in patients treated with baricitinib with nirmatrelvir/ritonavir.Results
The median age of the 117 included patients was 79 (interquartile range [IQR]: 70-85) years. Thirty-six patients received baricitinib with nirmatrelvir/ritonavir, 16 of whom died. The factors associated with reduced mortality were the administration of baricitinib with nirmatrelvir/ritonavir (hazard ratio [HR]: 0.405 (95% CI: 0.183-0.90), p = 0.026)). The IL-6 levels were 0.75 (IQR: 0.55-1.82) log₁₀ pg/mL before or within 2 days of baricitinib administration, and it was 1.45 (IQR: 0.94-2.07) log₁₀ pg/mL after baricitinib administration for 6 to 8 days. A mixed-effects model showed a statistically significant effect of Time on IL-6 levels (F(1, 20.757) = 6.299, p = 0.020). The fixed effects estimates indicated that each one-day increase during the treatment period, IL-6 levels increased by an average of 0.081 units (B = 0.081, SE = 0.032, t (20.757) = 2.510, p = 0.020, 95% CI (0.014, 0.148)). In patients treated with baricitinib, carbapenem-resistant Acinetobacter baumannii (2), carbapenem-resistant Klebsiella pneumoniae (2), and K. pneumoniae (2) were more common pathogens detected in the respiratory tract. Carbapenem-resistant K. pneumoniae (1), Enterococcus faecium (1), and Staphylococcus epidermidis (1) were detected in blood. Enterococcus faecium (2) and K. pneumoniae (1) were identified via urine culture.Conclusion
Baricitinib combined with nirmatrelvir/ritonavir was associated with lower mortality in elderly patients with severe or critical COVID-19 in the real world. Carbapenem-resistant A.baumanniiand carbapenem-resistant K. pneumoniae were more common pathogens detected in the respiratory tract in these patients.Clinical trial number
Not applicable.
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BibTeX
@article{xu2026effects,
title = {{Effects and infection risks of baricitinib in combination with nirmatrelvir/ritonavir in elderly patients with severe or critical COVID-19: a retrospective observational cohort study.}},
author = {Ling Xu and Yongzhe Liu and Ran Li and Chen Ma and Jun Liu and Boyuan Yang and Kewu Huang and Hangyong He and Li Gu},
journal = {BMC infectious diseases},
year = {2026},
month = aug,
doi = {10.1186/s12879-026-14144-2},
url = {https://europepmc.org/article/MED/42958072},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Effects and infection risks of baricitinib in combination with nirmatrelvir/ritonavir in elderly patients with severe or critical COVID-19: a retrospective observational cohort study.
AU - Ling Xu
AU - Yongzhe Liu
AU - Ran Li
AU - Chen Ma
AU - Jun Liu
AU - Boyuan Yang
AU - Kewu Huang
AU - Hangyong He
AU - Li Gu
PY - 2026
DA - 2026/08/01
JO - BMC infectious diseases
DO - 10.1186/s12879-026-14144-2
UR - https://europepmc.org/article/MED/42958072
AB - Background Baricitinib was shown to reduce the mortality of COVID-19 patients, but real world data about baricitinib in combination with nirmatrelvir/ritonavir for the treatment of elderly patients with severe or critical COVID-19 were limited. The aim of the study was to determine the effects and hospital-acquired infections occurrence after combined medication in these patients.Methods We included severe or critical COVID-19 patients treated at Beijing Chaoyang Hospital from December 2022 to February 2023. We investigated duration of hospital stay, factors associated with reduced mortality risk, IL-6 levels and the characteristics of hospital-acquired infections in patients treated with baricitinib with nirmatrelvir/ritonavir.Results The median age of the 117 included patients was 79 (interquartile range [IQR]: 70-85) years. Thirty-six patients received baricitinib with nirmatrelvir/ritonavir, 16 of whom died. The factors associated with reduced mortality were the administration of baricitinib with nirmatrelvir/ritonavir (hazard ratio [HR]: 0.405 (95% CI: 0.183-0.90), p = 0.026)). The IL-6 levels were 0.75 (IQR: 0.55-1.82) log₁₀ pg/mL before or within 2 days of baricitinib administration, and it was 1.45 (IQR: 0.94-2.07) log₁₀ pg/mL after baricitinib administration for 6 to 8 days. A mixed-effects model showed a statistically significant effect of Time on IL-6 levels (F(1, 20.757) = 6.299, p = 0.020). The fixed effects estimates indicated that each one-day increase during the treatment period, IL-6 levels increased by an average of 0.081 units (B = 0.081, SE = 0.032, t (20.757) = 2.510, p = 0.020, 95% CI (0.014, 0.148)). In patients treated with baricitinib, carbapenem-resistant Acinetobacter baumannii (2), carbapenem-resistant Klebsiella pneumoniae (2), and K. pneumoniae (2) were more common pathogens detected in the respiratory tract. Carbapenem-resistant K. pneumoniae (1), Enterococcus faecium (1), and Staphylococcus epidermidis (1) were detected in blood. Enterococcus faecium (2) and K. pneumoniae (1) were identified via urine culture.Conclusion Baricitinib combined with nirmatrelvir/ritonavir was associated with lower mortality in elderly patients with severe or critical COVID-19 in the real world. Carbapenem-resistant A.baumanniiand carbapenem-resistant K. pneumoniae were more common pathogens detected in the respiratory tract in these patients.Clinical trial number Not applicable.
SN - 1471-2334
ER -