| Autor: |
Mareev VY; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Orlova YA; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Plisuk AG; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Pavlikova EP; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Akopyan ZA; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Matskeplishvili ST; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow., Malahov PS; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow., Krasnova TN; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Seredenina EM; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Potapenko AV; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Agapov МA; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Asratyan DA; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow., Dyachuk LI; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Samokhodskaya LM; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Mershina EM; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Sinitsyn VE; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Mareev YV; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; National Medical Research Center of Therapy and Preventive Medicine, Moscow., Shatokhina EA; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow., Begrambekova YL; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow., Kamalov AA; Medical Research and Educational Center, Lomonosov Moscow State University, Moscow; School of Fundamental Medicine, Lomonosov Moscow State University, Moscow. |
| Abstrakt: |
Aim To evaluate clinical efficacy of the proactive anti-inflammatory therapy in patients hospitalized for COVID-19 with pneumonia and a risk of "cytokine storm".Material and methods The COLORIT study was a comparative study with randomization into 4 groups: colchicine (n=21) 1 mg for the first 3 days followed by 0.5 mg/day through day 12 or discharge from the hospital; secukinumab 300 mg/day, s.c., as a single dose (n=20); ruxolitinib 5 mg, twice a day (n=10); and a control group with no anti-inflammatory therapy (n=22). The effect was evaluated after 12±2 days of inpatient treatment or upon discharge, what comes first. For ethical reasons, completely randomized recruitment to the control group was not possible. Thus, for data analysis, 17 patients who did not receive any anti-inflammatory therapy for various reasons not related with inclusion into the study were added to the control group of 5 randomized patients. Inclusion criteria: presence of coronavirus pneumonia (positive PCR test for SARS-CoV-2 RNA or specific clinical presentation of pneumonia; IDC-10 codes U07.1 and U07.2); C-reactive protein (CRP) concentration >60 mg/l or its threefold increase from baseline; at least 2 of 4 symptoms (fever >37.5 °C, persistent cough, shortness of breath with inspiratory rate >20 per min or blood saturation with oxygen <94 % by the 7th-9th day of disease. The study primary endpoint was changes in COVID Clinical Condition Scale (CCS-COVID) score. The secondary endpoints were the dynamics of CRP and changes in the area of lung lesion according to data of computed tomography (CT) of the lungs from the date of randomization to 12±2 days.Results All three drugs significantly reduced inflammation, improved the clinical course of the disease, and decreased the disease severity as evaluated by the CCS score: in the ruxolitinib group, by 5.5 (p=0.004); in the secukinumab group, by 4 (p=0.096); in the colchicine group, by 4 (p=0.017), and in the control group, by 2 (р=0.329). In all three groups, the CCS-COVID score was 2-3 by the end of observation period, which corresponded to a mild process, while in the control group, the score was 7 (р=0.005). Time-related changes in CRP were significant in all three anti-inflammatory treatment groups with no statistical difference between the groups. By the end of the study, changes in CT of the lungs were nonsignificant.Conclusion In severe СOVID-19 with a risk of "cytokine storm", the proactive therapy with ruxolitinib, colchicine, and secukinumab significantly reduces the inflammation severity, prevents the disease progression, and results in clinical improvement. |
