ABSTRACT
Objective: It is aimed to determine the frequency of side effects seen in the use of antiviral, antibacterial and immunomodulatory drugs used in the treatment of coronavirus disease-2019 (COVID-19) in combination or monotherapy. Material and Methods: In this retrospective study, patients with a diagnosis of COVID-19 who received hydroxychloroquine, macrolide, and favipiravir treatments in combination or monotherapy were evaluated in terms of the development of side effects. Demographic and clinical data of the patients, other treatments they received and the side effects that occurred were recorded. Results: During the study period, data from 337 patients were analyzed. The median age of the patients was 56 (19-94), and 184 (54.6%) were male. Hypertension was the most common comorbidity (29.9%). Diffuse infiltration was detected in 210 (62.3%) of 272 (80.7%) patients with pneumonia. Eighteen (5.3%) patients received only hydroxychloroquine, 86 (25.5%) had only macrolide, 193 (57.3%) had hydroxychloroquine and macrolide, and 40 (11.9%) had hydroxychloroquine, macrolide and favipiravir triple combination. Side effects were observed in 2 (11.1%) patients receiving hydroxychloroquine monotherapy, 4 (4.7%) patients receiving macrolide monotherapy, 55 (28.5%) patients receiving hydroxychloroquine-macrolide combination, and 4 (10.0%) patients receiving hydroxychloroquine-macrolidefavipiravir combination. It was observed that the most common (12.9%) side effect in the group receiving the combination of hydroxychloroquine and macrolide was QT prolongation. The most common (7.3%) side effect of the gastrointestinal system was found to be nausea. Conclusion: The frequency of side effects increases when antiviral, antibacterial and immunomodulatory drugs used for the treatment of COVID-19 are used in combination.
ABSTRACT
BACKGROUND: Respiratory failure and death are the leading causes of severe Coronavirus disease 2019 (COVID-19). Hyper-inflammation and cytokine storm cause lung damage. This study aimed to compare the low-dose and high-dose effects of tocilizumab, an IL-6 receptor antagonist. METHOD: Patients with severe pneumonia and hyper-inflammation signs because of COVID-19 were included in this retrospective study. Patients receiving tocilizumab <200 mg intravenously were classified as the low-dose group, and receiving ≥200 mg as the high-dose group, and those not treated with tocilizumab as the control group. Demographic and clinical data of patients who died and survived in both low-high dose and control patients were compared. According to symptom day and radiological infiltration, patients with tocilizumab were also evaluated in two groups as early and late periods at tocilizumab administration time. RESULTS: A total of 160 patients were included in the study; 70 were treated with a low dose and 50 with high-dose tocilizumab. Forty patients were in the control group. Age, comorbidity and clinical features were similar in the control, low-dose tocilizumab and high-dose tocilizumab groups. The mortality rate (12.9%, 30.0%, 37.5, P = .008) was less in the low-dose tocilizumab group. The secondary infection rate was higher in the high-dose group than in the low-dose tocilizumab and control groups (44.0%, 10.0%, 10.0%, P < .001). Distinguishing between those patients who died and survived, age (OR: 1.1589, P < .001), higher APACHE II scores (OR: 1.225, P = .001) and needs for non-invasive mechanical ventilation (OR: 14.469, P < .001) were the most critical risk factors. Low-dose tocilizumab was associated with a lower mortality rate (OR: 0.244, P = .012). CONCLUSION: The use of tocilizumab at a low dose is associated with lower secondary infections and mortality.
Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19 Drug Treatment , Coinfection , Coinfection/prevention & control , Humans , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Diabetes mellitus (DM) increases mortality and morbidity in patients with coronavirus disease (COVID-19). In this study, it was aimed to assess factors influencing on COVID-19 pneumonia in hospitalized patients with diabetes and association with oral anti-diabetic drugs. MATERIALS AND METHODS: This cross-sectional study included 432 patients with type 2 diabetes mellitus diagnosed with COVID-19. Data regarding clinical characteristics, demographic characteristics, intensive care unit (ICU) rate in patients admitted to ICU, laboratory results on day 1 and 7, thoracic computed tomography (CT) findings and oral anti-diabetic drugs used were extracted from medical records. In all patients, 75-days mortality was recorded. Data were assessed independently. RESULTS: There was pneumonia in 386 (89.4%) of 432 patients with diabetes. The risk for pneumonia was markedly higher in patients on DPP-4 inhibitors; however, there was no significant among other oral anti-diabetic groups and subgroups. In addition, elevated CRP was linked to the increased risk for pneumonia. Only patients in the pneumonia group had SGLT-2 inhibitor use. During follow-up, 91 patients died. In Cox regression analysis, low Glasgow Coma Scale score, and increased lactate dehydrogenase levels were identified as significant independent risk factors for mortality. CONCLUSION: The study indicated that DPP-4 inhibitor used and elevated CRP level were associated with pneumonia development. Only patients in the pneumonia group had SGLT-2 inhibitor use. No oral anti-diabetics was found to be associated with COVID-19 related death.