Body mass index and baricitinib treatment effect in hospitalized adults with COVID-19: A secondary analysis of ACTT-2.
Rachel Rigsby, Timothy G Gaulton
PMID 42247829WHAT IT FOUND
Baricitinib plus remdesivir did not show a substantially different recovery benefit across BMI in hospitalized adults with COVID-19.
Diabetes and hypertension also did not change the recovery benefit.
Key findings
01Baricitinib plus remdesivir did not show a substantially different recovery benefit across BMI from 20 to 45 kg/m2; hazard ratios for faster recovery were 1.11 to 1.26, and the treatment-by-BMI interaction test was P = .64.
02Across four BMI and diabetes or hypertension phenotype groups, estimated recovery hazard ratios were 1.11 to 1.26, and the subgroup-by-treatment interaction test was P = .90.
03Among 842 participants not receiving mechanical ventilation or ECMO at baseline, 78 progressed by day 15; the composite outcome occurred in 6.1% of baricitinib plus remdesivir participants and 12.5% of placebo plus remdesivir participants, and odds ratios across BMI from 20 to 45 kg/m2 were 0.53 to 0.35 with interaction P = .69.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis used data from ACTT-2, which was conducted early in the pandemic before widespread vaccination, new viral variants, and routine corticosteroid use, so it may not match current treatment protocols. The confidence intervals for treatment effect estimates were wide, especially at BMI extremes, so smaller but clinically meaningful differences by BMI cannot be excluded. The analysis excluded participants with BMI below 18.5 kg/m2 or 50 kg/m2 or higher, so it does not address those groups. Metabolic phenotype was defined only by BMI and diabetes or hypertension history because lipid levels, blood pressure, fasting glucose, and insulin resistance were not collected. Body composition and baricitinib plasma concentrations were not measured, so the study cannot directly test whether obesity changes drug exposure. 43 participants with missing BMI were excluded, although missingness did not differ by treatment assignment.
Declared interests
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The easy way to misread this
Do not read the null interaction as proof that BMI cannot modify baricitinib response. The confidence intervals were wide, especially at BMI extremes, and the authors state that clinically meaningful heterogeneity cannot be excluded.