Tocilizumab fails survival benefit in severe COVID-19 – A retrospective cohort study

Objectives: Anti-interleukin-6 monoclonal antibody, tocilizumab, has produced mixed results in clinical trials for effectiveness against coronavirus disease 2019 (COVID-19). We conducted a retrospective cohort study to compare outcomes at 28 days of a cohort of patients with severe COVID-19 treated with tocilizumab and standard care, with those receiving standard care only. Materials and Methods: In this record-based retrospective cohort study, patients hospitalised with COVID-19 were classified into non-severe and severe disease as per institutional protocol. One cohort received tocilizumab with standard care and the second cohort received only standard care. Few patients also received high-dose steroids as ‘pulse’ steroids on initial clinical deterioration. Data were collected for the treatment given including oxygen interface, steroids, antimicrobials, duration of hospital stay in survivors, requirement of mechanical ventilation, and day of intubation from symptom onset. The primary outcome was to compare the all-cause mortality between the two groups. The effect of pulse steroid therapy on all-cause mortality was studied in the secondary outcome. Results: There was statistically significant mortality in the tocilizumab cohort as compared to standard care alone (HR 2.43, 95% CI 1.54–3.89). The need for mechanical ventilation was more in the tocilizumab cohort (85% vs. 18%, P < 0.001). Tocilizumab cohort had a delay in the day of intubation by a mean of 2.29 days from the day of symptom onset (P < 0.05). Pulse steroid administration showed increased all-cause mortality (HR 1.94, 95% CI 1.18–3.20) and risk of mechanical ventilation. Conclusion: Tocilizumab cohort showed higher mortality and need for mechanical ventilation in our study which contrasts the result of a few previous trials. Our study warrants the need for future clinical trials on this subject to ensure better treatment strategies in upcoming COVID-19 waves.

Two Cases of Lupus Miliaris Disseminatus Faciei Treated with Oral Mini-pulse Steroid Therapy / 대한피부과학회지

Lupus miliaris disseminatus faciei (LMDF) is a rare granulomatous skin disease mainly affecting the central area of the face. A variety of treatments are reportedly of some benefit; however, controlled studies to establish the best treatment are lacking. Here, we report the cases of a 33-year-old man who presented with multiple, various-sized, erythematous maculopapules on the face and a 19-year-old man who presented multiple, reddish papuloplaques distributed on the face. Histopathological examinations of the two cases revealed large clear-boundary epithelioid cell granulomas with central necrosis surrounded by lymphocytic infiltration. Based on the clinical and histological findings, diagnoses of LMDF were made. As oral tetracycline and antimalarials were not fully effective in our cases, oral mini-pulse steroid therapy (dexamethasone, 5 mg bid for 2 days per week) was initiated. After several months, the eruption significantly improved, and most lesions were resolved. Here, we report two cases of LMDF successfully treated with oral mini-pulse steroid therapy.

Clinical Features and the Effect of High-Dose Steroid Therapy in Korean Optic Neuritis Patients

PURPOSE: To investigate the clinical manifestation and response to high-dose steroid therapy in Korean optic neuritis patients. METHODS: We retrospectively reviewed the medical records of 13 patients diagnosed with optic neuritis who were treated with high-dose steroid and who were followed-up for more than three months in Seoul National University Hospital between January 2005 and December 2008. RESULTS: Pain on extraocular movement (EOM) and disc swelling were observed in 61% (8/13) patients diagnosed with optic neuritis. Visual acuity (VA) improved to more than 20/40 in 77% (10/13) of patients after high-dose steroid therapy. The patients who resolved within one month recovered VA a mean of 18 days after onset. The recovery period had nothing to do with the initial time of high-dose steroid therapy. CONCLUSIONS: Pain on EOM was less frequently observed and disc swelling was more frequent in Korean patients than have been reported in Caucacian patients. The recovery period of optic neuritis was not influenced by the initial time of high-dose steroid therapy.

Nursing Care for Patients Accepting Pulse Steroid Therapy / 中国康复理论与实践

@#Objective To establish the nursing care for the patients with pulse steroid therapy, and to investigate its effect. Methods 78 patients who accepted pulse steroid therapy in the past 4 years were analyzed retrospectively, in which, 42 within past 2 years （2008 and 2007) were as pulse steroid nursing care group, and other 36 patients before 2 years (2007 and 2006) were as routine nursing care group. Results 3 weeks after the pulse steroid therapy, in pulse steroid nursing care group, proximal muscle weakness were found in 8 patents, insomnia in 18 patients; while in routine nursing care groups, proximal muscle weakness were found in 16 patents, and insomnia in 25 patients（P<0.05）. Conclusion Pulse steroid nursing care can reduce the incidence of muscle weakness and insomnia after pulse steroid therapy significantly.