Role of Janus Kinase inhibitors in the management of pulmonary involvement due to Long COVID-19 disease: A case control study
Pawan Kumar Singh1
, Vinod Kumar Sharma1, Lokesh Kumar Lalwani2, Dhruva Chaudhry1, Manjunath B. Govindagoudar1, Chaudhari Pramod Sriram1, Aman Ahuja1
1Department of Pulmonary and Critical Care Medicine, Pt BDS Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
2Department of Respiratory Medicine, Pt BDS Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
Keywords: Baricitinib, Janus kinase inhibitors, long coronavirus disease 2019, postcoronavirus disease, tofacitinib
Abstract
OBJECTIVES: Ongoing symptomatic coronavirus disease 2019 (OSC) is defined as persistent symptoms beyond 4 weeks of acute illness. OSC leads to prolonged hospitalization and oxygen dependence. We aimed to find the outcome of Janus kinase inhibitors (JAKi) as a steroid sparing agent to treat OSC.
METHODS: In this single center case controlled study comparing JAKi and corticosteroids in OSC cases, data of 41 cases out of 86 were included – 21 in the JAKi group and 20 in the corticosteroid group from 4 weeks of acute illness to the next 4 weeks. Clinical parameters and inflammatory markers were recorded. The primary outcome was to compare the proportion of patients who were able to maintain oxygen saturation ≥95% with any oxygen supplementation in the two groups.
RESULTS: The baseline clinical and demographic characteristics were similar in the two groups. The age was 53.65 ± 9.8 years and 51.48 ± 14.0 years in the corticosteroid group and JAKi group, respectively. At the baseline, 85% of patients in the corticosteroid group and 85.8% in the JAKi group were on oxygen support. The most common symptom in both groups was breathlessness followed by cough. Twenty percent of patients in the JAKi group received baricitinib and the remaining were given tofacitinib. At the time of follow up, the majority of cases had a significant reduction in C reactive protein (CRP) and D dimer; however, the change in CRP and D dimer was similar in both groups. The number of patients off oxygen support at 4 weeks was higher in the JAKi group (85% in the corticosteroid group vs. 95.2% in the JAKi group, P = 0.269), and the median time to liberation from oxygen support was significantly lower in JAKi group (19 days in corticosteroid group vs. 9 days in JAKi group, P < 0.001). The frequency of any adverse event was also higher in the corticosteroid group (70% vs. 23.8%, P = 0.003).
CONCLUSION: JAKi can be used as immunomodulatory drugs in hypoxic OSC cases having evidence of ongoing inflammation.
How to cite this article: Singh PK, Sharma VK, Lalwani LK, Chaudhry D, Govindagoudar MB, Sriram CP, et al. Role of Janus Kinase inhibitors in the management of pulmonary involvement due to Long COVID-19 disease: A case control study. Turk J Emerg Med 2023;23:149-55.
Data were retrieved from the medical records department after due permission from the Ethics Committee. Being a retrospective study, the informed consent process was waivered off vide letter number: 196, dated December 12, 2021.
• Conceptualization – PKS, DC, VS
• Data collection – VS, CPS, LKL
• Data curation – PKS, MBG
• Formal analysis – PKS, CPS
• Funding acquisition – Not applicable
• Investigation – Not Applicable
• Methodology – PKS, MBG, VS
• Project administration – DC
• Resources – DC, PKS
• Software – PKS
• Supervision – DC
• Validation – AA, LKL
• Visualization – Not Applicable
• Writing – original draft – PKS, MBG, CPS
• Writing – review and editing – DC, AA, LKL.
None declared.vvvvvvv
None.
We would express our heartiest gratitude toward the patients who participated in the current study.