Case Report: Home-based Management of Severe COVID-19 with Low-dose Tofacitinib

Am J Trop Med Hyg. 2021 Oct 4;105(6):1472-1475. doi: 10.4269/ajtmh.21-0737.

Abstract

Human lives and nations' economies have been adversely affected worldwide by the COVID-19 pandemic. The hyperinflammatory state associated with the disease may be related to mortality. Systemic glucocorticoid is the first-line therapy for cytokine storm. Various immunomodulatory drugs such as tocilizumab and baricitinib have been used in those not responding to glucocorticoid monotherapy. Amid the peak crisis of COVID-19 in India, there was an extreme paucity of medications, oxygen, and hospital beds. We describe three patients with COVID-19 who received low-dose tofacitinib (an oral Janus kinase inhibitor) in addition to moderate-dose glucocorticoid. These patients were treated at their homes, as the hospitals were short of beds. Rapid reduction in hypoxemia along with gradual resolution of other signs of the disease were observed. The results are reassuring regarding the feasibility of managing of severe COVID-19 outside the hospital setting when healthcare resources are overwhelmed by pandemic-related caseload.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • COVID-19 Drug Treatment*
  • Cytokine Release Syndrome / prevention & control
  • Cytokines / genetics
  • Cytokines / metabolism
  • Enoxaparin / administration & dosage
  • Enoxaparin / therapeutic use
  • Female
  • Gene Expression Regulation / drug effects
  • Humans
  • Methylprednisolone / administration & dosage
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Piperidines / administration & dosage
  • Piperidines / therapeutic use*
  • Prednisone / administration & dosage
  • Prednisone / therapeutic use
  • Pyrimidines / administration & dosage
  • Pyrimidines / therapeutic use*
  • SARS-CoV-2*

Substances

  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • Cytokines
  • Enoxaparin
  • Piperidines
  • Pyrimidines
  • tofacitinib
  • Prednisone
  • Methylprednisolone