Anti-Inflammatory Treatment of COVID-19 Pneumonia With Tofacitinib Alone or in Combination With Dexamethasone is Safe and Possibly Superior to Dexamethasone as a Single Agent in a Predominantly African American Cohort

Maroun E Hayek; Michael Mansour; Harrison Ndetan; Quentin Burkes; Robert Corkern; Ammar Dulli; Reya Hayek; Karim Parvez; Satwinder Singh

doi:10.1016/j.mayocpiqo.2021.03.007

Anti-Inflammatory Treatment of COVID-19 Pneumonia With Tofacitinib Alone or in Combination With Dexamethasone is Safe and Possibly Superior to Dexamethasone as a Single Agent in a Predominantly African American Cohort

Mayo Clin Proc Innov Qual Outcomes. 2021 Jun;5(3):605-613. doi: 10.1016/j.mayocpiqo.2021.03.007. Epub 2021 Mar 27.

Authors

Maroun E Hayek¹, Michael Mansour¹, Harrison Ndetan², Quentin Burkes¹, Robert Corkern¹, Ammar Dulli¹, Reya Hayek³, Karim Parvez¹, Satwinder Singh¹

Affiliations

¹ Delta Regional Medical Center, Greenville, MS.
² Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, Tyler, TX.
³ University of Mississippi Medical School, Jackson, MS.

Abstract

Objective: To explore the survival benefit of tofacitinib in addition to dexamethasone in hospitalized patients treated for coronavirus disease 2019 (COVID-19)-related pneumonia.

Patients and methods: This is a single-center retrospective observational study. All patients who were hospitalized at Delta Regional Medical Center (a regional hospital in the Mississippi Delta) with a COVID-19 diagnosis and discharged between March 1 and September 30, 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), versus 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 (31.8%) in the tofacitinib group and 30 (68.2%) in the dexamethasone group. The proportions of death among the tofacitinib and dexamethasone groups were, respectively, 10.1% and 22.9%. 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% CI: 0.12 to 0.76; P=.01).

Conclusion: The in-patient treatment of COVID-19 pneumonia has rapidly evolved. The addition of dexamethasone has made a relevant improvement on survival. Other immunomodulators have yet to show an impact. Here we present the potential survival benefit of the Janus kinase-signal transducer and activator of transcription 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.

Keywords: AOR, adjusted odds ratio; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; CT, computed tomography; DRMC, Delta Regional Medical Center; IL, interleukin; JAK, Janus kinase; OR, odds ratio; PCR, polymerase chain reaction; STAT, Signal transducer and activator of transcription.