498. Baricitinib in Patients with Severe Pneumonia due to COVID-19 in Veracruz, Mexico
Authors: Del Carpio-Orantes Luis , García-Méndez Sergio , Zamudio-Severino Gustavo Miguel , Sánchez-Díaz Jesús Salvador , Navarrete-Espinosa Benito , Rivera-Viñas Miguel Ángel , Salas-González Arturo , aguilar-silva Andrés , Cruz-Albarrán Sonia , Denis-Bravo Jorge Luis , Esparza-Mora Iván , González-Medel Karem Samantha , Hernández-Zaleta Nelyda Verania , López-Cruz Edgar Alberto , Montano-Montiel Laura Guadalupe , Morgado-Hernández Jennifer Ivonne , Muñoz-Aguilar José Alberto , Priego-Parra Edson Irving , Reich-Sierra Reynaldo , Sánchez-Jiménez Noel Jhosimar , Tress-Uc María Fernanda , Velázquez-Orozco Paola , Contreras-Sánchez Edna Rosario , Medrano-Rios Luis Jaime , Ruiz-Castro Enrique , Ortiz-Hernández Manuel Alejandro 
Published: December 2021

Abstract

Background
Patients affected by COVID-19 pneumonia who present severe symptoms with manifest hypoxemia and cytokine storm have a high mortality rate, which is why therapies focused on reducing inflammation and improving lung function have been used, one of them being jakinibs through of the blocking of the JAK tracks.

Methods
Patients who presented data of severe pneumonia due to COVID-19 with data of severe hypoxemia and cytokine storm were selected, from June to August 2020, to whom the SaO2/FiO2 ratio is measured at the beginning, intermediate and end of treatment, as well as D dimer and serum ferritin. Comorbidity and drugs taken previously are analyzed. The patients being cared for at home.

Results
We included data from 30 patients, 8 (27%) women and 22 (73%) men, with a median age of 58.5 (46.5 - 68.0) years. 23 patients (77%) had comorbidities, the most frequent being arterial hypertension (43%), followed by obesity (30%), type 2 diabetes mellitus (27%), among others. In the laboratory, the medians of D-Dimer 982 ng/mL, Ferritin 1,375 ng/mL and C-Reactive Protein 10.0 mg/dL. Regarding the use of previous medications, we found that 29 (97%) patients had treatment with some medication, the most frequent: azithromycin (77%), ivermectin (53%) and dexamethasone (47%). The median number of medications received was 3. The initial pulse oximetry (SaO2) measurement with room air had a median of 80.5% and the median SaO2/FiO2 (SAFI) was 134; Regarding the type of SIRA, 90% had moderate SIRA and 10% had severe SIRA.
The median day of evolution on which baricitinib was started was 10 days, all received 4 mg/day, and the median days of treatment with baricitinib was 14.0 days. At follow-up, SaO2 at 7 days had a median of 93.0% and the median SAFI at 7 days was 310.0; the median SaO2 at 14 days was 95.0% and the median SAFI at 14 days was 452.0. In comparative analysis, baseline SaO2/SAFI was significantly lower compared to 7 and 14 days (p = 0.001 for both comparisons). The outcomes, 27 (90%) patients improved and there were 3 (10%) who died.
Demographic Variables

Respiratory Variables

Results on SAFI and SaO2

Conclusion
Baricitinib therapy in these patients with severe COVID-19 pneumonia who present with severe hypoxemia and cytokine storm presented good results by improving clinical status and pulmonary failure, with patients being cared for at home and avoiding mechanical ventilation.

Disclosures
All Authors: No reported disclosures