Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial has demonstrated that baricitinib, an anti-inflammatory drug normally used to treat rheumatoid arthritis, reduces the risk of death when given to hospitalised patients with severe COVID-19. The benefit was in addition to those of dexamethasone and tocilizumab, two other anti-inflammatory treatments which have previously been shown to reduce the risk of death in these patients.

Packet and tablets of baricitinib © Cambridge University Hospitals NHS Foundation Trust

The University of Oxford-led RECOVERY trial has been testing a range of potential treatments for patients admitted to hospital for COVID-19 since March 2020. Between February and December 2021, 4008 patients randomly allocated to usual care alone were compared with 4148 patients who were randomly allocated to usual care plus baricitinib. The dose of baricitinib tablets was 4mg once daily for 10 days (or until discharge from hospital if sooner). At randomisation, 95% of patients were receiving a corticosteroid such as dexamethasone, 23% were receiving tocilizumab, and 20% were receiving the anti-viral drug remdesivir. Two-thirds (68%) of patients were receiving oxygen and one quarter (27%) were receiving additional respiratory support.

Treatment with baricitinib significantly reduced deaths: 513 (12%) of the patients in the baricitinib group died within 28 days compared with 546 (14%) patients in the usual care group, a reduction of 13% (age-adjusted rate ratio 0.87, 95% confidence interval [CI] 0.77 to 0.98; p= 0.026). The benefit of baricitinib was consistent regardless of which other COVID-19 treatments the patients were also receiving, including corticosteroids, tocilizumab, or remdesivir.

Patients receiving baricitinib were also more likely to be discharged alive within 28 days (80% vs. 78%, age-adjusted rate ratio 1.10, 95% CI 1.04-1.15; p<0.001). Among patients not on invasive mechanical ventilation when entered into the trial, baricitinib reduced the chance of progressing to invasive mechanical ventilation or death from 17% to 16% (risk ratio 0.90, [95% CI 0.81 to 0.99], p=0.026). There was no evidence that the short course of baricitinib used in RECOVERY increased the risk of other infections or of thrombosis (complications of blood clotting).

RECOVERY considerably strengthens the evidence from earlier trials that baricitinib is beneficial in severe COVID-19, and provides new evidence of the additional benefit of baricitinib on top of other immunomodulatory treatments. RECOVERY is twice as large as the eight previous trials of baricitinib and similar drugs (known as JAK inhibitors) for the treatment of COVID-19 combined. Overall the nine trials, which involve about 12,000 patients, found that the use of baricitinib (or another JAK inhibitor) reduced deaths in patients hospitalised for COVID-19 by about one-fifth (rate ratio 0.80, 95% CI 0.71 to 0.89; p<0.001).

"This result confirms and extends earlier findings, providing greater certainty that baricitinib is beneficial and new data to guide the treatment of COVID-19 patients with a combination of drugs to dampen the immune response. As always, the next challenge is ensuring this and other COVID-19 treatments are available and affordable for everyone who can benefit, regardless of where they live", said Professor Sir Peter Horby, Joint Chief Investigator for RECOVERY.

The full story is available on the RECOVERY website

This news is also posted on the University of Oxford website

Similar stories

Indian authorities sign an MoU for a data and skill-sharing partnership between ICMR and IDDO

The Indian government’s Union Cabinet, chaired by Prime Minister Shri Narendra Modi, has approved a Memorandum of Understanding (MoU) between the Indian Council of Medical Research (ICMR) and the Infectious Diseases Data Observatory (IDDO), based at the University of Oxford.

The GRAM Project has moved

The Global Research on Antimicrobial Resistance (GRAM) Project has a new centre of operations at the University of Oxford, after moving this month from the Big Data Institute to the Centre for Tropical Medicine and Global Health, under the leadership of Dr. Benn Sartorius (PI) and Prof. Christiane Dolecek (co-PI).

Sharing expertise with scientific collaborators in India

The Indian Council for Medical Research (ICMR) National Institute of Malaria Research (NIMR) and IDDO collaborate on a joint capacity building venture to train young researchers across three infectious diseases: malaria, visceral leishmaniasis and lymphatic filariasis

Artemisinin combination therapy trials need longer follow-up to detect late treatment failures for Plasmodium falciparum malaria

WWARN researchers have been assessing the recommended minimum follow-up period in capturing polymerase chain reaction (PCR)-confirmed recrudescence following treatment with fixed-dose artemisinin combination therapies (ACTs) for patients with uncomplicated Plasmodium falciparum malaria.

Paxlovid to be investigated by the RECOVERY Trial as a potential treatment for patients hospitalised with COVID-19

The RECOVERY Trial begins testing the antiviral treatment Paxlovid. Paxlovid, an oral antiviral treatment developed by Pfizer, is a combination of nirmatrelvir and ritonavir. Nirmatrelvir inhibits an enzyme that is critical for the replication of the virus that causes COVID-19, whilst ritonavir increases the concentration of nirmatrelvir.

The RECOVERY Trial - two years on

One trial. Over 47,000 participants. Nearly 200 hospital sites, across six countries. Ten results. Four effective COVID-19 treatments. And behind them all, an army of countless researchers, doctors, nurses, statisticians and supporting staff.