ruxolitinib to combat covid-19

Conditions: COVID-19

Summary: the investigators hypothesize that jak 1/2 inhibition with ruxolitinib, an fda approved treatment for intermediate or high-risk myelofibrosis, could have a similar effect in patients with severe covid-19, quelling the immune-hyperactivation, allowing for clearance of the virus and reversal of the disease manifestations.


Eligibility criteria:
inclusion criteria: * a diagnosis of advanced covid-19 as defined by both of the following: * a positive test for sars-cov-2 rna detected by rt-pcr collected from the upper respiratory tract (nasopharyngeal and oropharyngeal swab) and, if possible, the lower respiratory tract (sputum, tracheal aspirate, or bronchoalveolar lavage), analyzed by a clia certified lab * critical disease manifested by any of the following: * chest imaging (ct or chest x-ray permitted) with ≥ 50% lung involvement * respiratory failure requiring invasive mechanical ventilation or supplementary oxygen with fio2 ≥ 50% * shock (defined as mean arterial pressure ≤ 65 mmhg unresponsive to 25ml/kg isotonic intravenous fluid resuscitation and/or requiring vasopressor support * cardiac dysfunction defined by: * new global systolic dysfunction with ejection fraction ≤ 40% * takotsubo cardiomyopathy * new onset supraventricular or ventricular arrhythmias * plasma troponin i ≥ 0.10 ng/ml in someone without previously documented troponin elevation beyond that level * elevated plasma nt-probnp in someone without documented prior elevation * if age \ 450 pg/ml * if age 50-74, nt-probnp \> 900 pg/ml * if age ≥ 74, nt-probnp \> 1800 pg/ml * receipt of investigational or off-label agents for covid-19 (prior or ongoing) does not exclude eligibility. * patients who have received autologous or allogeneic stem cell transplant are eligible at the discretion of the investigators. * 18 years of age or older at the time of study registration * adequate hematologic function defined as: * absolute neutrophil count ≥ 1000/mm3 * platelet count ≥ 50,000/mm3 without growth factor or transfusion support for 7 days prior to screening * creatinine clearance ≥ 15 ml/minute or receiving renal replacement therapy * women of childbearing potential (defined as women with regular menses, women with amenorrhea, women with irregular cycles, women using a contraceptive method that precludes withdrawal bleeding, or women who have had a tubal ligation) are required to have a negative pregnancy test and use two forms of acceptable contraception, including one barrier method, during participation in the study treatment period. * male patients (if engaging in reproductive sex with a women of childbearing potential) are required to use two forms of acceptable contraception, including one barrier method, during participation in the study and throughout the evaluation period. * able to understand and willing to sign an irb approved written informed consent document (or that of legally authorized representative, if applicable) exclusion criteria: * known allergy or intolerance to ruxolitinib or another jak inhibitor. * known or suspected active viral (including hiv, hepatitis b, and hepatitis c), bacterial, mycobacterial, or fungal infection other than covid-19. virologic testing not required unless infection is suspected. * pregnant and/or breastfeeding. * any uncontrolled intercurrent illness that would put the patient at greater risk or limit compliance with study requirements in the opinion of the investigator.