Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Editorial
. 2021 Jul 29;385(5):463-465.
doi: 10.1056/NEJMe2108667.

JAK Inhibitors - More Than Just Glucocorticoids

Justin Stebbing  1 , Volker M Lauschke  1
Affiliations
Editorial

JAK Inhibitors - More Than Just Glucocorticoids

Justin Stebbing et al. N Engl J Med. .
No abstract available

PubMed Disclaimer

Figures

Figure 1
Figure 1. Overview of Current Therapies for Covid-19 with Effects on Mortality.
Early stages of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are characterized by high viral loads in the respiratory tract, which then decrease with progressing disease (red line). Inversely, the levels of inflammatory markers, including the proinflammatory cytokine interleukin-6 and type I interferons, increase with disease severity and respiratory distress (blue line). These observations suggest that antiviral agents are likely to be most effective in early stages of infection during the first week after symptom onset when disease is still mild to moderate. In contrast, immunomodulatory and antiinflammatory treatment is most effective in later stages of disease (ordinal scale score of 4 to 7; see below). Thus far, randomized, controlled trials have shown that treatment with glucocorticoids, Janus kinase inhibitors, and perhaps interleukin-6 receptor antagonists reduces mortality among patients with severe coronavirus disease 2019 (Covid-19). In contrast, antiviral agents have not been shown to have beneficial effects on survival. The ordinal scale of Covid-19 severity refers to definitions from the National Institute of Allergy and Infectious Diseases. The categories of the ordinal scale are as follows: a score of 1 indicates that the patient was not hospitalized, with no limitations on activities; 2, was not hospitalized but had limitation on activities or was receiving supplemental oxygen at home; 3, was hospitalized, without use of supplemental oxygen and no ongoing medical care; 4, was hospitalized and not receiving supplemental oxygen but was receiving ongoing medical care; 5, was hospitalized and receiving supplemental oxygen through low-flow devices; 6, was hospitalized and receiving oxygen through noninvasive ventilation or high-flow oxygen devices; 7, was hospitalized and receiving invasive mechanical ventilation or extracorporeal membrane oxygenation; and 8, died. Category 8 is not shown here.
See this image and copyright information in PMC

Comment on

  • Tofacitinib in Patients Hospitalized with Covid-19 Pneumonia.
    Guimarães PO, Quirk D, Furtado RH, Maia LN, Saraiva JF, Antunes MO, Kalil Filho R, Junior VM, Soeiro AM, Tognon AP, Veiga VC, Martins PA, Moia DDF, Sampaio BS, Assis SRL, Soares RVP, Piano LPA, Castilho K, Momesso RGRAP, Monfardini F, Guimarães HP, Ponce de Leon D, Dulcine M, Pinheiro MRT, Gunay LM, Deuring JJ, Rizzo LV, Koncz T, Berwanger O; STOP-COVID Trial Investigators. Guimarães PO, et al. N Engl J Med. 2021 Jul 29;385(5):406-415. doi: 10.1056/NEJMoa2101643. Epub 2021 Jun 16. N Engl J Med. 2021. PMID: 34133856 Free PMC article. Clinical Trial.

References

    1. Gottlieb RL, Nirula A, Chen P, et al. Effect of bamlanivimab as monotherapy or in combination with etesevimab on viral load in patients with mild to moderate COVID-19: a randomized clinical trial. JAMA 2021;325:632-644. - PMC - PubMed
    1. Horby P, Lim WS, Emberson JR, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021;384:693-704. - PMC - PubMed
    1. Cao Y, Wei J, Zou L, et al. Ruxolitinib in treatment of severe coronavirus disease 2019 (COVID-19): a multicenter, single-blind, randomized controlled trial. J Allergy Clin Immunol 2020;146:137-146.e3. - PMC - PubMed
    1. Kalil AC, Patterson TF, Mehta AK, et al. Baricitinib plus remdesivir for hospitalized adults with Covid-19. N Engl J Med 2021;384:795-807. - PMC - PubMed
    1. Guimarães PO, Quirk D, Furtado RH, et al. Tofacitinib in patients hospitalized with Covid-19 pneumonia. N Engl J Med 2021;385:406-415. - PMC - PubMed