Tofacitinib Associated with Reduced Intubation Rates in the Management of Severe COVID-19 Pneumonia: A Preliminary Experience
Pawan K Singh, Lokesh K Lalwani, Manjunath B Govindagoudar, Preeti Gehlaut
Citation Information :
Singh PK, Lalwani LK, Govindagoudar MB, Gehlaut P. Tofacitinib Associated with Reduced Intubation Rates in the Management of Severe COVID-19 Pneumonia: A Preliminary Experience. Indian J Crit Care Med 2021; 25 (10):1108-1112.
Background: The second wave of COVID-19 pandemic was not only associated with a rapid and severe surge in the number of cases but also limited availability of recommended medicines. Baricitinib has been known to reduce recovery time in COVID-19 pneumonia in association with remdesivir. Tofacitinib, with limited evidence, was used in severe COVID-19 pneumonia based on its similarity of action with baricitinib.
Methods: Data of all patients admitted to the COVID-19 intensive care unit in the month of April were accessed and analyzed. Data of patients who were on other immunomodulators, invasive ventilation, or suffering from end-stage organ diseases were excluded from the analysis.
Results: Out of 73 patients, data of 50 were analyzed. Twenty-five received tofacitinib and the other 25 were managed with standard of care. Age, comorbidities, and gender distribution between the two groups were similar. On day 7 of admission, the change in SpO2/FiO2 ratio was 1.26 ± 1 and 0.72 ± 1 in the tofacitinib group and control group, respectively. Similarly, a higher number of subjects in the control group showed worsening in the World Health Organization (WHO) ordinal scale (36 vs 12%, p = 0.01). The clinical objective improvement was similar in the two groups. The intubation rates in the tofacitinib group were significantly lower than that in the control group (32% vs 8%, p = 0.034).
Conclusion: Tofacitinib, in this retrospective single-center experience, was found to be associated with reduced intubation rates and reduced worsening in the WHO ordinal scale. There was no difference in mortality in the two groups.
Soin AS, Kumar K, Choudhary NS, Sharma P, Mehta Y, Kataria S, et al. Tocilizumab plus standard care versus standard care in patients in India with moderate to severe COVID-19-associated cytokine release syndrome (COVINTOC): an open-label, multicentre, randomised, controlled, phase 3 trial. Lancet Respir Med 2021;9(5):511–521. DOI: 10.1016/S2213-2600(21)00081-3.
Kalil AC, Patterson TF, Mehta AK, Tomashek KM, Wolfe CR, Ghazaryan V, et al. Baricitinib plus remdesivir for hospitalized adults with covid-19. New Engl J Med 2020;384(9):795–807. DOI: 10.1056/NEJMoa2031994.
Hodge JA, Kawabata TT, Krishnaswami S, Clark JD, Telliez JB, Dowty ME, et al. The mechanism of action of tofacitinib - an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis. Clin Exp Rheumatol 2016;34(2):318–328. www.clinexprheumatol.org/abstract.asp?a=9615
Hayek ME, Mansour M, Ndetan H, Burkes Q, Corkren R, Dulli A, et al. 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;5(3):605–613. DOI: 10.1016/j.mayocpiqo.2021.03.007.
Panés J, Gisbert JP. Efficacy of tofacitinib treatment in ulcerative colitis. Gastroenterol Hepatol 2019;42(6):403–412. DOI: 10.1016/j.gastrohep.2019.03.002.
Welfare GoIMoHaF. Clinical management protocol: covid-19. In: Services DGoH, editor. New Delhi: MoHFW; 2020. p. 23.
Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB. Comparison of the SpO2/FiO2 ratio and the PaO2/FiO2 ratio in patients with acute lung injury or ARDS. Chest 2007;132(2):410–417. DOI: 10.1378/chest.07-0617.
Herson J. Clinical trial preparations for the next pandemic. Contemp Clin Trials 2021;102:106292. DOI: 10.1016/j.cct.2021.106292.
Bhattacharjee S. Drug shortage hits patients. The Hindu 2021;Sect. Cities.
Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. Dexamethasone in hospitalized patients with covid-19. N Engl J Med 2021;384(8):693–704. DOI: 10.1056/NEJMoa2021436.
Chaudhry D, Singh PK. Tocilizumab and COVID-19. Indian J Crit Care Med 2020;24(9):741–743. DOI: 10.5005/jp-journals-10071-23608.
Kalil AC, Patterson TF, Mehta AK, Tomashek KM, Wolfe CR, Ghazaryan V, et al. Baricitinib plus remdesivir for hospitalized adults with covid-19. New Engl J Med 2021;384(9):795–807. DOI: 10.1056/NEJMoa2031994.
Rizk JG, Kalantar-Zadeh K, Mehra MR, Lavie CJ, Rizk Y, Forthal DN. Pharmaco-immunomodulatory therapy in COVID-19. Drugs 2020;80(13):1267–1292. DOI: 10.1007/s40265-020-01367-z.
Banerjee A, Goswami RP, Chatterjee M. Network theoretic analysis of JAK/STAT pathway and extrapolation to drugs and viruses including COVID-19. Sci Rep 2021;11(1):2512. DOI: 10.1038/s41598-021-82139-x.
Nicola M, O'Neill N, Sohrabi C, Khan M, Agha M, Agha R. Evidence based management guideline for the COVID-19 pandemic - review article. Int J Surg 2020;77:206–216. DOI: 10.1016/j.ijsu.2020.04.001.
Tofacitinib. Drugs and Lactation Database (LactMed). Bethesda (MD): National Library of Medicine (US); 2006.