Tofacitinib may be beneficial for hospitalised patients with COVID-19 pneumonia

In patients hospitalised with COVID-19, excess inflammation generally underlies clinical progression. By reducing cytokine production, Janus kinase (Jak) inhibitors tamp down inflammation. Now, investigators report results of an industry-supported trial of the Jak inhibitor tofacitinib in 289 patients in Brazil with COVID-19 pneumonia.

Progression to death or respiratory failure occurred significantly less often with tofacitinib than placebo (18% vs. 29%; risk ratio, 0.63). Death from any cause and clinical status on an ordinal scale were more favourable in the tofacitinib group, but these differences were not statistically significant. Rates of serious infections or thromboembolic events were similar in both groups.

Accumulating evidence shows that adding Jak inhibitors to corticosteroids improves outcomes in hospitalised patients receiving supplemental oxygen but not requiring mechanical ventilation. The NIH and the Infectious Diseases Society of America both endorse the use of the Jak inhibitor baricitinib in selected hospitalised patients.