Benefits of early aggressive immunomodulatory therapy (tocilizumab and methylprednisolone) in COVID-19: Single center cohort study of 685 patients.

Autor:	Luis BM; Infectious Diseases Unit, Internal Medicine, Hospital de Burgos, Spain., Miguel MB; Intensive Care, Hospital de Burgos, Spain., Pedro DL; Neurosurgery, Hospital de Burgos, Spain., David IP; Intensive Care, Hospital de Burgos, Spain., Itziar A; Pediatrics, Biocruces Bizkaia Health Research Institute, Hospital Universitario de Cruces, University of the Basque Country UPV/EHU, Baracaldo, Spain., Ana GH; Infectious Diseases Unit, Internal Medicine, Hospital de Burgos, Spain.; Neurosurgery, Hospital de Burgos, Spain., Enrique IJ; Systemic Autoimmune Diseases, Internal Medicine Department, Hospital de Burgos, Spain., María LV; Systemic Autoimmune Diseases, Internal Medicine Department, Hospital de Burgos, Spain., Noelia TF; Systemic Autoimmune Diseases, Internal Medicine Department, Hospital de Burgos, Spain., Julio César BB; Systemic Autoimmune Diseases, Internal Medicine Department, Hospital de Burgos, Spain., Marta UI; Pharmacy Department, Hospital de Burgos, Spain., Rodrigo SL; Anesthesiology Department, Hospital de Burgos, Spain., María CB; Reumatology Department, Hospital de Burgos, Spain., Andrés LM; Reumatology Department, Hospital de Burgos, Spain., Javier MI; Pneumology Department, Hospital de Burgos, Spain., Juan Pablo GM; Pneumology Department, Hospital de Burgos, Spain., Gerardo HF; Hematology Department, Hospital de Burgos, Spain., Carolina NF; Infectious Diseases Unit, Internal Medicine, Hospital de Burgos, Spain., Jorge BL; Internal Medicine, Hospital de Burgos, Spain., María FR; Infectious Diseases Unit, Internal Medicine, Hospital de Burgos, Spain., Fernando CT; Intensive Care, Hospital de Burgos, Spain., Sergio OE; Intensive Care, Hospital de Burgos, Spain., Lourdes FC; Intensive Care, Hospital de Burgos, Spain., María GE; Intensive Care, Hospital de Burgos, Spain., Gregoria ML; Microbiology Department, Hospital de Burgos, Spain., Adolfo SR; Pneumology Department, Hospital de Burgos, Spain., José Antonio FR; Intensive Care, Hospital de Burgos, Spain.
Jazyk:	angličtina
Zdroj:	Journal of translational autoimmunity [J Transl Autoimmun] 2021; Vol. 4, pp. 100086. Date of Electronic Publication: 2021 Feb 12.
DOI:	10.1016/j.jtauto.2021.100086
Abstrakt:	Introduction: A growing evidence suggests that immune dysregulation and thrombotic phenomena are key features in the pathophysiology of COVID-19. Apart from antivirals and respiratory support, anticoagulants, corticoids and immunomodulators are increasingly being prescribed, especially for more severe cases. We describe the clinical outcome of a large cohort of patients preferentially treated with glucocorticoids and interleukin inhibitors. Methods: Single center and retrospective case series. Adult patients admitted with COVID-19 related respiratory insufficiency were included. Patients who died within 2 days after admission and those testing positive but asymptomatic were excluded. We defined two study periods: from March 3rd to March 31 st, 2020 (beginning of epidemic until peak of incidence) and April 1 st to May 7 th, 2020 (second half of epidemic). The majority of patients received respiratory support, combinations of antimicrobials, anticoagulants, corticoids and interleukin inhibitors. Antivirals were preferentially given in the first period. The clinical outcome (death and ventilator dependency) of both periods was compared. Results: From March 3 rd to May 7 th, 685 patients were included for analysis (58.4% males, mean age 68.9 years). Patients in the first period (n ​= ​408) were younger (66.6 vs 71.1 years, p ​= ​0.003), presented lower mean P a O 2/F i O2 ratio at admission (256.5 vs 270.4 ​mm Hg,p ​= ​0.0563), higher ferritin (1520 vs 1221 ​ng/ml, p ​= ​0.01), higher IL-6 (679 vs 194 ​pg/ml, p ​< ​0.0001) and similar D-dimer levels (3.59 vs 3.39 ​μg/mL, p ​= ​0.65) compared to the second period (n ​= ​277). Lopinavir/ritonavir and interferon were preferentially given in the first period (23.8% and 32% vs 1.8% and 11.9%, p ​< ​0.0001). Use of corticoids (88.2% vs 87.4%, p ​= ​0,74) and tocilizumab (26.29 vs 20.22% p ​= ​0.06) were similarly administered in both periods. Patients in the second period needed less mechanical ventilation (4.9% vs 16.9%, p ​< ​0.0001), fewer ICU admission (6.1% vs 20.1%,p ​< ​0.0001) and showed similar mortality (17.7% vs 15.4%, p ​= ​0.43). Infectious and thrombotic complications were comparable in both periods (both around 8%, with no statistical difference). Patients treated with tocilizumab (n ​= ​163) had lower mortality rate compared to those untreated under the same indication (7.9% vs 24.2%, p ​< ​0.0001). Conclusions: In this large retrospective COVID-19 in-hospital cohort, lopinavir/ritonavir and interferon showed no significant impact on survival. Extensive use of corticosteroids and tocilizumab resulted in good overall outcome and showed acceptable complication rates. Competing Interests: The authors declare no competing financial interests. (© 2021 The Author(s).)
Databáze:	MEDLINE
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