Correlation of tocilizumab vs baricitinib with secondary bacterial and fungal infections in patients with COVID-19

PURPOSE: The study's objective was to determine whether tocilizumab or baricitinib has a higher risk of bacterial and fungal infections secondary to coronavirus disease 2019 (COVID-19) infection. METHODS: This single-site, retrospective chart review of 150 patients at a 433-bed community teaching hospital aimed to investigate the rate of secondary bacterial or fungal infections following COVID-19 infection in patients treated with tocilizumab or baricitinib from March 2020 to June 2022. Secondary endpoints included the time to hospital discharge, the rate of all-cause mortality, and the number of ventilator-free days. RESULTS: Among the patients included in the study, the average age was 56.7 years, 55.3% were male, and 72.0% were unvaccinated. Tocilizumab (46.7%) was initiated more frequently than baricitinib (22.7%) in the intensive care units. For the primary endpoint of post-COVID-19 secondary infections, the baricitinib group had a lower rate (21.3%) than the tocilizumab group (34.7%) (P = 0.101). With respect to the secondary endpoints, the median hospital length of stay, rate of mortality, and number of ventilator days were higher in the tocilizumab group. CONCLUSION: This study found no significant differences in the incidence of secondary infections and time to secondary infections between patients treated with baricitinib and tocilizumab.