Treatment
Tofacitinib was administered at a dose 10 mg twice daily on day 1, followed by 5 mg twice daily on day 2-5. The dosage was reduced to 5 mg once daily in patients with eGFR less than 60 ml/min/1.73 m2. The dosage and duration of treatment were chosen based on the approved dosage of tofacitinib for rheumatoid arthritis. We felt that more intensive immunosuppression, that is, the administration of tofacitinib at a higher dose or for a longer course would be unnecessary and could be hazardous for patients with an active viral infection. Certain side effects of tofacitinib, including infections due to bacterial or viral pathogens, lymphopenia and venous thromboembolic events are particularly relevant for hospitalised patients with COVID-19 [13].
All patients received standard of care treatment from the time of hospital admission according to the Russian COVID-19 guidelines. Standard of care treatment was administered at the physician’s discretion and included oxygen supply if needed (target oxygen saturation at least 93%), hydroxychloroquine (400 mg twice on day 1, followed by 200 mg twice per day on days 2–5), azithromycin, lopinavir-ritonavir (400/100 mg twice daily), and low molecular weight heparin according to bodyweight and kidney function. Intravenous administration of dexamethasone was also permitted at a dose not exceeding 16 mg daily.