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

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

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.