Mayo Clin Proc Innov Qual Outcomes. 2021 Mar 27. doi: 10.1016/j.mayocpiqo.2021.03.007. Online ahead of print.
OBJECTIVE: To explore the survival benefit of tofacitinib in addition to dexamethasone in hospitalized patients treated for COVID-19 pneumonia.
PATIENTS AND METHODS: Single center retrospective observational study. All patients hospitalized, at Delta Regional Medical Center, regional hospital in the Mississippi Delta, with a COVID-19 diagnosis and discharged between March 1st and September 30th, 2020 are included. The primary outcome was in-hospital mortality in relation to receipt of tofacitinib alone or in addition to dexamethasone (designated as the Tofacitinib Group), vs dexamethasone alone (designated as the Dexamethasone Group).
RESULTS: Of 269 eligible patients, 138 (51.3%) received tofacitinib uniformly and 131 (48.7%) patients received dexamethasone without tofacitinib. A total of 44 patients expired: 14 (31.82%) in the Tofacitinib Group and 30 (68.18%) in the Dexamethasone Group. The proportions of death among the Tofacitinib and Dexamethasone groups were respectively, 10.14% and 22.90%. This represents a 70% reduction in odds of dying among the Tofacitinib group compared to the Dexamethasone group after adjusting for age and clinical parameters captured at hospitalization (adjusted odds ratio=0.30, 95% confidence interval =0.12-0.76; p=0.01).
CONCLUSIONS: The in-patient treatment of COVID-19 pneumonia has rapidly evolved. The addition of dexamethasone has made a relevant improvement on survival. Other immunomodulators are yet to show an impact. Here we present the potential survival benefit of the JAK-STAT inhibitor tofacitinib on COVID-19 pneumonia. We found that adding tofacitinib based anti-inflammatory therapy to a treatment regimen including dexamethasone in COVID-19 pneumonia seems to have potential benefit of improving survival when compared to dexamethasone alone.