Remarks

• Along with baricitinib, corticosteroids should also be administered in patients with severe or critical COVID-19 (see Section 6.10).
• IL-6 receptor blockers (tocilizumab or sarilumab) have previously been recommended for the treatment of patients with severe or critical COVID-19 (see Section 6.5). An IL-6 receptor blocker and baricitinib should not be given together, and should be viewed as alternatives. The choice of whether to use baricitinib or an IL-6 receptor blocker depends on availability, as well as clinical and contextual factors (see Justification).

Practical Info Additional considerations are available in a summary of practical issues. Useful information can also be found in the United States Food and Drug Administration (FDA) fact sheet for health care providers, based on the emergency use authorization (EUA) of baricitinib (20). Here follows a brief summary of key points: Route, dosage and duration:

• The recommended dose is 4 mg daily orally in adults with eGFR ≥ 60 mL/min/1.73 m2 .
• A duration of 14 days of total treatment or until hospital discharge, whichever is first. The optimal duration of treatment is unknown, and the proposed duration reflects what was used in the trials providing evidence on treatment effects of baricitinib. Dose regimen adjustment:
• Patients with leukopenia, renal impairment or hepatic impairment (note: these parameters should be monitored during treatment);
• Patients taking strong organic anion transporter 3 (OAT3) inhibitors (e.g. probenecid), there are drug interactions which warrant dose reductions. Timing: Baricitinib (like IL-6 receptor blockers) should be initiated at the same time as systemic corticosteroids; specific timing during hospitalization or the course of illness is not specified.