Tofacitinib versus standard of care treatment in patients with COVID-19 pneumonia and respiratory failure: a multicenter cohort study

Background: The JAK(Janus kinase)/STAT(signal transducers and activators of transcription) are members of a cytokine receptor signal pathway implicated in the COVID-19 cytokine storm. The objective of this multicenter cohort study was to assess the efficacy of tofacitinib (multiple JAKs inhibitor) in reducing the risk of death in a cohort of patients with COVID-19 pneumonia and respiratory failure (SpO2 on ambient air ≤ 93%) received standard of care treatment (SoC). Methods: Overall, 257 patients with COVID-19 associated pneumonia were included in our study: 72 of them were treated with tofacitinib, whereas 185 patients received only SoC. Patients from tofacitinib and control groups were well-matched by age, gender, body mass index, comorbidities, oxygen saturation, and various laboratory parameters. We conducted a survival analysis by treatment groups with death as the primary endpoint. Results: The primary endpoint was reached in 8(11.1%) of 72 patients who were treated with tofacitinib and 21(11.4%) of 185 patients who received SoC alone (p>0.05). Unweighted Kaplan-Meier estimates showed no beneficial effect of treatment with tofacitinib compared with standard of care only. At day 14 after hospital admission, the proportion of patients with the primary outcome was 9.7% in the tofacitinib group versus 10.3% in the control group (log rank p>0.05). In Cox regression analysis, addition of tofacitinib to SoC did not result in a reduced risk of primary outcome. Conclusion: Addition of tofacitinib to standard of care COVID-19 pneumonia treatment was not associated with a reduced mortality rate.