Tofacitinib and pirfenidone as rescue therapies for severe COVID‐19 in a patient with previously stable interstitial lung disease associated with Sjögren syndrome

Abstract

AbstractCoronavirus disease 2019 (COVID‐19) can lead to pulmonary fibrosis due to the inflammatory process in the lung, resulting in a series of respiratory consequences. Patients with underlying systemic diseases or pre‐existing pulmonary diseases are particularly at risk of severe respiratory distress and persistent pulmonary abnormalities. Pirfenidone, a well‐known anti‐fibrotic agent recognized for its therapeutic effect on idiopathic pulmonary fibrosis, could be a feasible option in severe COVID‐19 cases given the similar pathophysiological features shared with interstitial lung diseases. In this paper, we share our experience of early administration of pirfenidone in combination with tofacitinib in a 61‐year‐old female patient with severe COVID‐19 pneumonia. Pirfenidone was initiated because of persistent dependence on high‐flow oxygen support and even the requirement for mechanical ventilation due to disease progression after initial standard COVID‐19 treatment. The patient was successfully extubated 15 days after the initiation of pirfenidone, and 13 days after extubation, she was completely weaned off supplemental oxygen. A series of chest radiographs and computed tomography scans demonstrated notable improvements in her lung condition. We propose a strategy of using pirfenidone plus tofacitinib as a rescue therapy in the management of patients with severe COVID‐19.