Tofacitinib lowers risk of death or respiratory failure in COVID-19 pneumonia: NEJM
Researchers have found in a new study that among patients hospitalized with Covid-19 pneumonia, tofacitinib led to a lower risk of death or respiratory failure through day 28 than placebo.
In this randomized, double-blind, placebo-controlled trial involving hospitalized patients with Covid-19 pneumonia, tofacitinib was superior to placebo in reducing the incidence of death or respiratory failure through day 28. These effects were consistent regardless of sex, age, duration of symptoms, and use of glucocorticoids at baseline; they were also consistent across different levels of supplemental oxygen use at baseline
The positive findings from the STOP-COVID study (NCT04469114) evaluating the efficacy and safety of oral Janus kinase (JAK) inhibitor tofacitinib in 289 hospitalized adult patients with COVID-19 pneumonia who were not on ventilation have been published in New England Journal of Medicine.
The trial was a research collaboration between Pfizer and the ARO from the Hospital Israelita Albert Einstein in Sao Paulo, Brazil, which was the trial coordinating center. It is important to note that tofacitinib has not been approved or authorized for use by any regulatory authority worldwide for the treatment of COVID-19 and tofacitinib should not be used in patients with an active serious infection.
The trial demonstrated a lower cumulative incidence of death or respiratory failure through day 28 – the primary outcome of the study – with tofacitinib (18.1%) compared to placebo (29.0%) (risk ratio 0.63; 95% confidence interval [CI], 0.41 to 0.97; p=0.04). Death from any cause through day 28 occurred in 2.8% of patients in the tofacitinib group and in 5.5% in the placebo group (hazard ratio 0.49; 95% CI, 0.15 to 1.63).
Serious adverse events occurred in 20 patients (14.1%) in the tofacitinib group and 17 (12.0%) in the placebo group. Among protocol-specified adverse events of special interest, deep vein thrombosis, acute myocardial infarction, ventricular tachycardia, and myocarditis occurred in one patient each in the tofacitinib group; hemorrhagic stroke and cardiogenic shock occurred in one patient each in the placebo group. The incidence of serious infection was 3.5% in the tofacitinib group and 4.2% in the placebo group.
"We are encouraged by the initial findings of our randomized trial of tofacitinib in patients hospitalized with COVID-19 pneumonia. These results provide new information which indicates that the use of tofacitinib when added to standard of care, which includes glucocorticoids, may further reduce the risk of death or respiratory failure in this patient population," said Otavio Berwanger, M.D., Ph.D., Director of the Academic Research Organization, Hospital Israelita Albert Einstein. "The study builds on the hypothesis that JAK inhibition could mitigate systemic and alveolar inflammation in patients with COVID-19-related pneumonia."
"To effectively combat the COVID-19 pandemic, there remains a critical need for multiple therapeutic options to treat patients who have contracted the virus," said Tamas Koncz, M.D., Ph.D., Chief Medical Officer, Pfizer Inflammation & Immunology. "As outlined in Pfizer's five-point plan at the onset of the COVID-19 pandemic, we are keenly focused on working across the healthcare ecosystem with partners like Hospital Israelita Albert Einstein. We look forward to our continued collaboration as we analyze the full dataset from this study and assess next steps."
The multi-center, randomized, double-blind, placebo-controlled trial included adult patients hospitalized with COVID-19 pneumonia receiving standard of care. Patients were randomized in a 1:1 ratio to receive either tofacitinib 10 mg twice daily plus standard of care or placebo twice daily plus standard of care for up to 14 days or until hospital discharge. Overall, 89.3% used glucocorticoids during hospitalization, predominantly dexamethasone.
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DOI: 10.1056/NEJMoa2101643
