ABSTRACT
Objective: Tocilizumab (T) and corticosteroids (C) were two of the drugs used to stop the hyperinflammatory state of critically ill patients at the beginning of the COVID-19 pandemic. The objective of this study is to make a comparison of the efficacy and safety between the two drugs and the combination of both. Material and/or methods: All patients with SARSCOV2 infection from our centre during the first wave of the pandemic who had been treated with T, C or a combination of both (CT) were selected from the IDI-REM- 2020-01 COVID-19 Registry (NCT04347278). A descriptive study was carried out with an assessment of survival, mean stay (MS) in Intensive care unit (ICU) and risk of co-infection for these treatments. Results: Of 86 patients (54 men/32 women), 29 received T (33.7%), 37 C (43.1%) and 20 TC (23.2%). Median age was 66 ± 14 years, increasing in C (71 ± 15) and decreasing in T (60 ± 12) and TC (67 ± 13). The 48.9% of the patients with T and TC were admitted to the ICU compared to 8.1% of the patients with C, data related to age criteria. The median MS in the ICU decreased in the CT group at 7(±4) days compared to the T group (15 ± 3). There was no difference between the three therapies for general hospitalization MS (21 ± 5.5 to 23 ± 5.3). The 55.2% of the patients treated with T and 30% treated with CT had co-infection compared to 21.6% of the patients treated with C. Finally, a Kaplan-Meier analysis was performed, verifying a trend to have a longer survival in patients treated with T and CT, compared to C, although without statistical significance (χ2: 0.161) by sample size. Conclusions: CT appears to be more effective than T and C in patients with severe COVID-19 disease. These results support the limited literature;however, more powered studies will be required to evaluate these results.
ABSTRACT
Objective: To explore the role of the drugs used to treat COVID-19 in the haematological alterations identified in patients hospitalized due to SARS-CoV-2 infection. Material and/or methods: Post-authorization observational study of 245 patients with confirmed SARS-CoV-2 (COVID-19) infection hospitalized and treated between March and April 2020 in five hospital centres in the Cantabria region. To be included in this study, complete information on the treatment used and periodic haematological examinations must be available. The data was taken from the COVID-19 Registry (NCT04347278). Results: One hundred forty-five of 245 patients (59.2%) presented haematological alterations during the acute process of infection. Leukopenia-lymphopenia appeared in 64% of the cases with alterations in the blood count and 42% presented thrombopenia. In 80% of the cases, this alteration resolved as soon as the clinical evolution of the patient improved. The following drugs were used to treat this infection: hydroxychloroquine (97.9%), lopinavir-ritonavir (82%), interferon beta-1b (7.7%), tocilizumab (20.4%) and anakinra (3,3%). The additional treatments used were enoxaparin (87.3%), methylprednisolone (23.6%), as well as antibiotics, antifungals and antivirals in patients with coinfections. A compatible temporal relationship was identified between the administration of tocilizumab and the appearance of leukopenia or worsening of pre-existing leukopenia in 40% of patients, with leukocyte recovery being observed 72 h after discontinuation of the drug. No temporal relationship was observed when other drugs were used. Regarding thrombopenia, the use of linezolid was causally involved in 8% of the patients, showing resolution in 60% of the cases when the drug was discontinued. Conclusions: Patients infected by COVID-19 can develop leukopenia-lymphopenia and thrombopenia in relation to infection by the virus itself. Tocilizumab in case of leukocyte involvement and linezolid in case of platelet decline have been shown to play a role in these haematological alterations.