The Janus kinase inhibitor baricitinib is just as effective as dexamethasone for patients hospitalised with COVID-19 and has a superior safety profile, a landmark study shows.

The results from the first head-to-head trial of its kind could help doctors decide which immunomodulator to use, based on patient risk of dexamethasone-related side effects, international researchers say.

“For the bedside clinician, a more individually tailored choice of immunomodulation now appears possible, where side-effect profile, ease of administration, cost and patient comorbidities can all be considered,” the US-led team reported.

To compare the efficacy and safety of the two drugs, the investigators — from five countries — assigned 1010 patients (mean age 58) with laboratory-confirmed SARS-CoV-2 infection to either baricitinib or dexamethasone, in addition to the antiviral remdesivir and a placebo.