Clinical efficacy and safety of combination therapy of tocilizumab and steroid pulse therapy for critical COVID-19 in HD patients
| Autor: | Kazuhiko Sekine, Ayumi Yoshifuji, Masataro G. Toda, Kentaro Fujii, Munekazu Ryuzaki, Takahide Kikuchi, Kazuto Itoh, Yasushi Kondo |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Combination therapy Physiology Secondary infection medicine.medical_treatment Anti-Inflammatory Agents Antibodies Monoclonal Humanized Methylprednisolone Gastroenterology chemistry.chemical_compound Tocilizumab Renal Dialysis Physiology (medical) Internal medicine Oxygen therapy medicine Humans Cytokine storms Adverse effect Glucocorticoids Survival rate Dexamethasone Aged Retrospective Studies Aged 80 and over business.industry COVID-19 Steroid pulse therapy Middle Aged COVID-19 Drug Treatment Treatment Outcome chemistry Pulse Therapy Drug Nephrology Hemodialysis Drug Therapy Combination Female Kidney Diseases Original Article Cytokine Release Syndrome business medicine.drug |
| Zdroj: | Clinical and Experimental Nephrology |
| ISSN: | 1437-7799 1342-1751 |
| DOI: | 10.1007/s10157-021-02126-4 |
| Popis: | Background Critical coronavirus disease 2019 (COVID-19) has a high fatality rate, especially in hemodialysis (HD) patients, with this poor prognosis being caused by systemic hyperinflammation; cytokine storms. Steroid pulse therapy or tocilizumab (TCZ) have insufficient inhibitory effects against cytokine storms in critical cases. This study evaluated the clinical effects and safety of combining steroid pulse therapy and TCZ. Methods From September 2020 to May 2021, 201 patients with COVID-19 were admitted to our hospital. Before February 2021, patients with an oxygen demand exceeding 8 L/min were intubated and treated with standard therapy (dexamethasone and antiviral therapy). After February 2021, patients underwent high-flow nasal cannula oxygen therapy and were treated with TCZ (8 mg/kg) and methylprednisolone (mPSL) (500 mg/day [≤ 75 kg], 1000 mg/day [> 75 kg]) for 3 days. We compared background characteristics, laboratory findings, and prognosis between non-HD and HD patients and between patients who received and did not receive TCZ and mPSL pulse therapy. Results Among non-HD patients, the TCZ + mPSL pulse group had significantly higher survival rates and lower secondary infection rates (p Conclusion TCZ combined with mPSL pulse therapy improved the survival rate without significant adverse events in critical HD and non-HD patients with COVID-19 by strongly suppressing systemic hyperinflammation. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink