Transient leukocytopenia following combination therapy for COVID-19

Tsuchiya, Kazuo; Fujisawa, Tomoyuki; Mochizuka, Yasutaka; Takuma, Sho; Oishi, Kyohei; Endo, Yoshinari; Tanaka, Yuko; Fukada, Atsuki; Watanabe, Hirofumi; Katsumata, Mineo; Aoshima, Yoichiro; Inoue, Yusuke; Suzuki, Yuzo; Karayama, Masato; Hozumi, Hironao; Furuhashi, Kazuki; Enomoto, Noriyuki; Nakamura, Yutaro; Inui, Naoki; Suda, Takafumi

BACKGROUND: Combination therapy with dexamethasone, remdesivir, and baricitinib has become a promising treatment for moderate or severe COVID-19; however, we have observed transient leukocytopenia in COVID-19 patients who received combination therapy. METHODS: Twelve consecutive COVID-19 patients treated with combination therapy were included in this retrospective analysis. Blood cell counts collected at the following three time points were analyzed: before the start of therapy (period 1), within 24 h of starting therapy (period 2), and within 48 h of period 2 (period 3). RESULTS: The leukocyte count significantly decreased in period 2 compared to period 1 and then significantly increased in period 3 without withdrawal of baricitinib. The neutrophil count transiently decreased in period 2 and recovered in period 3. CONCLUSIONS: Clinicians should be aware of transient leukocytopenia in patients with COVID-19 during the early phase of combination therapy.