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1.
Neuroimmunology Reports ; 3:100162, 2023.
Article in English | ScienceDirect | ID: covidwho-2165735

ABSTRACT

Background Reports of neurological involvement are building up ever since COVID-19 has become a pandemic. Although rare, SARS-CoV-2 encephalopathy is a devastating complication associated with poor prognosis. Cytokine storm has been implicated in its pathophysiology. Case presentation We are reporting two paediatric patients who have contracted with COVID-19 and developed encephalopathy, who presented with status epilepticus and altered consciousness. Early aggressive immunosuppressive treatment was initiated promptly and both of them were able to recover without neurological deficit. Conclusion Patients with SARS-CoV-2 encephalopathy should be put on immunosuppressive therapy early for better neurological outcome. This improvement after the use of immunosuppressants further strengthened the cytokine storm theory in SARS-CoV-2 encephalopathy.

2.
Médecine et Maladies Infectieuses Formation ; 2022.
Article in French | ScienceDirect | ID: covidwho-2165716

ABSTRACT

Résumé Nous rapportons deux cas de réactivation tuberculeuse après COVID-19 sous corticostéroïdes et tocilizumab. Ils ont présenté une lymphopénie, des signes cliniques limités, une présentation radiologique inhabituelle mais des prélèvements microbiologiques positifs. Le dépistage de l'infection tuberculeuse latente (ITL) étant inapproprié dans ce contexte, il faudrait discuter de la traiter systématiquement chez des patients les plus à risque en cas de traitement immunomodulateur. We report cases of tuberculosis reactivation after COVID-19 treated with corticosteroids and tocilizumab. Both patients had lymphopenia and limited clinical signs. Radiological findings were unusual but microbiological samples were positive. As screening for latent tuberculosis with IGRA seems unappropriate in this context, latent tuberculosis treatment should be discussed while introducing immunomodulatory treatment for patients at risk.

3.
International Immunopharmacology ; 115:109623, 2023.
Article in English | ScienceDirect | ID: covidwho-2165421

ABSTRACT

Background This study sought to evaluate and compare the effectiveness of plasmapheresis, Tocilizumab, and Tocilizumab with plasmapheresis treatment on the removal of inflammatory cytokines and improvement clinically of patients with severe COVID-19 in Intensive Care Units (ICU) due to the association between increased cytokine release and the severity of COVID-19. Methods This clinical trial study was conducted in three treatment arms in Iran. All patients received standard care and randomization into one of three treatment groups;Tocilizumab (TCZ) alone, plasmapheresis alone, or a combination of Tocilizumab and plasmapheresis. Demographics, clinical evaluation, oxygenation status, laboratory tests and imaging data were evaluated in the three groups and re-checked 48 h after the end of treatment trials. Primary outcomes were oxygenation status, the need for mechanical ventilation and the rate of death. Results Ninety-four patients were included in the trial after meeting the eligibility requirements. Twenty-eight patients received Tocilizumab alone, 33 had plasmapheresis alone, and 33 received both Tocilizumab and plasmapheresis. Baseline characteristics did not differ between three groups that included demographic, clinical and laboratory parameters. Following therapy, there was no difference between the three groups for CRP, ferritin, d-dimer, IL-6, pro-calcitonin and neutrophil to lymphocyte ratio (NLR) (P > 0.05). While a significant reduction was found in CRP levels within each group (32.04 ± 42.43 to 17.40 ± 38.11, 51.28 ± 40.96 to 26.36 ± 33.07 and 41.20 ± 34.27 to 21.56 ± 24.96 in the tocilizumab, plasmapheresis, and combined group, respectively) (p < 0.05), procalcitonin levels were elevated significantly in the Tocilizumab group (0.28 ± 0.09 to 0.37 ± 0.11) (p < 0.05). Clinically there was no difference between the three groups following treatment for O2 saturation levels with supplementary oxygen at discharge, endotracheal intubation rate, use of NIVPP, mortality, mean hospital and ICU length of stay (p > 0.05). Conclusion Study results showed that the reduction of serum inflammatory markers, the rate of intubation and therapeutic complications including death were no different between the three groups;however, CRP levels were significantly reduced in all three groups, indicating that the interventions reduced inflammation likely through a reduction in the cytokine storm, though clinical outcomes were unaffected.

4.
Farmacia Hospitalaria ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165297

ABSTRACT

Objective: To describe the marginal cost and survival of patients treated with tocilizumab in a university hospital under real-life conditions and to evaluate factors that could influence costs and health outcomes will be evaluated. Methods: Observational, single-center, retrospective study of a cohort of adult patients infected with SARS-COV2 treated with tocilizumab. The 1 year restricted mean survival time was analyzed in life-years gained (LYG). The influence of sex, age and severity on patient survival was evaluated. The marginal cost/LYG and marginal cost/survivor ratios were calculated. Results: 508 patients (66 ± 13 years;32% women) were included. Seventeen percent were admitted to the ICU. Overall survival was 77%. Age older than 71.5 years (HR = 1.08;95%CI 1.07–1.10;p < 0.001) and ICU admission at initiation of treatment (HR = 2.01;95%CI 1.30–3.09;p = 0.002) were identified as risk factors. The total budgetary impact of tocilizumab in the period analyzed was 206,466 euros. The patients with the highest cost per unit of health outcome were those admitted to the ICU and those over 71.5 years, with a marginal cost/LYG of €966 and a marginal cost/survivor of €1136. Conclusion: The efficiency of treatment with tocilizumab is associated with the age and severity of the patients. The figures are lower in all subgroups than the thresholds usually used in cost-effectiveness evaluations. The results of the present study suggest that early first dose of tocilizumab is an efficient strategy. RESUMEN Objetivo: Describir el coste marginal y la supervivencia de los pacientes tratados con tocilizumab en un hospital universitario en condiciones de vida real. Y evaluar los factores que podrían influir los costes y los resultados en salud. Metodología: Estudio observacional, retrospectivo y unicéntrico de una cohorte de pacientes adultos infectados con SARS-COV2 tratados con tocilizumab. Se analizó, en años de vida ganados (AVG), la media de supervivencia restringida a 1 año. Se evaluó la influencia del sexo, la edad y la gravedad en la supervivencia de los pacientes. Se calcularon el ratio coste marginal/AVG y coste marginal/superviviente. Resultados: Se incluyeron 508 pacientes (66 ± 13 años;32% mujeres). Un 17% ingresó en UCI. La supervivencia global fue del 77%. Se identificaron como factores de riesgo la edad mayor de 71,5 años (HR = 1,08;IC95% 1,07–1,10;p < 0,001), y el ingreso en UCI al iniciar el tratamiento (HR = 2,01;IC95% 1,30–3,09;p = 0,002). El impacto presupuestario total de tocilizumab en el periodo analizado ascendió a 206.466€. Los pacientes con mayor coste por unidad de resultado en salud son los pacientes ingresados en UCI y mayores de 71,5 años, que presentan un coste marginal/AVG de 966 € y un coste marginal/superviviente de 1.136€. Conclusión: La eficiencia del tratamiento con tocilizumab se asocia a la edad y a la gravedad de los pacientes. Las cifras son inferiores en todos los subgrupos a los umbrales habitualmente utilizados en las evaluaciones coste-efectividad. Los resultados del presente estudio sugieren que el inicio precoz de tocilizumab es una estrategia eficiente.

5.
Medicina Clínica (English Edition) ; 159(12):569-574, 2022.
Article in English | ScienceDirect | ID: covidwho-2159526

ABSTRACT

Background and aim The most effective way to control severity and mortality rate of the novel coronavirus disease (COVID-19) is through sensitive diagnostic approaches and an appropriate treatment protocol. We aimed to identify the effect of adding corticosteroid and Tocilizumab to a standard treatment protocol in treating COVID-19 patients with chronic disease through hematological and lab biomarkers. Materials and methods This study was performed retrospectively on 68 COVID-19 patients with chronic disease who were treated by different therapeutic protocols. The patients were categorized into four groups: control group represented the patients' lab results at admission before treatment protocols were applied;group 1 included patients treated with anticoagulants, Hydroxychloroquine, and antibiotics;group 2 comprised patients treated with Dexamethasone;and group 3 included patients treated with Dexamethasone and Tocilizumab. Results The WBC and neutrophil counts were increased significantly in group 3 upon the treatment when they were compared with patients in group 1 (p=0.004 and p=0.001, respectively). The comparison of C-reactive Protein (CRP) level at admission was higher in group 3 than in group 1 with p=0.030. After 10 days of treatment, CRP level was decreased in all groups, but in group 3 it was statistically significant (p=0.002). Conclusion The study paves the way into the effectiveness of combining Dexamethasone with Tocilizumab in treatment COVID-19 patients with chronic diseases. Resumen Antecedentes y objetivo La forma más eficaz de controlar la gravedad y la tasa de mortalidad de la enfermedad del nuevo coronavirus (COVID-19) es mediante enfoques de diagnóstico sensibles y un protocolo de tratamiento adecuado. Nuestro objetivo fue identificar el efecto de agregar corticosteroides y tocilizumab a un protocolo de tratamiento estándar en el tratamiento de pacientes con COVID-19 con enfermedad crónica a través de biomarcadores hematológicos y de laboratorio. Materiales y métodos Este estudio se realizó de forma retrospectiva en 68 pacientes COVID-19 con enfermedad crónica que fueron tratados por diferentes protocolos terapéuticos. Los pacientes se clasificaron en cuatro grupos: el grupo de control representaba los resultados de laboratorio de los pacientes en el momento de la admisión antes de que se aplicaran los protocolos de tratamiento;el grupo 1 incluyó a pacientes tratados con anticoagulantes, hidroxicloroquina y antibióticos;el grupo 2 estaba compuesto por pacientes tratados con dexametasona;y el grupo 3 incluyó a pacientes tratados con dexametasona y tocilizumab. Resultados Los recuentos de glóbulos blancos y neutrófilos aumentaron significativamente en el grupo 3 tras el tratamiento cuando se compararon con los pacientes del grupo 1 (p=0,004 y p=0,001, respectivamente). La comparación del nivel de proteína C reactiva (CRP) al ingreso fue mayor en el grupo 3 que en el grupo 1, con p=0,030. Después de 10 días de tratamiento, el nivel de CRP disminuyó en todos los grupos, pero en el grupo 3 fue estadísticamente significativo (p=0,002). Conclusión El estudio allana el camino hacia la eficacia de la combinación de dexametasona con tocilizumab en el tratamiento de pacientes con COVID-19 con enfermedades crónicas.

6.
Farmacia Hospitalaria ; 2022.
Article in Spanish | ScienceDirect | ID: covidwho-2158844

ABSTRACT

Resumen Objetivo: Describir el coste marginal y la supervivencia de los pacientes tratados con tocilizumab en un hospital universitario en condiciones de vida real. Y evaluar los factores que podrían influir los costes y los resultados en salud. Metodología: Estudio observacional, retrospectivo y unicéntrico de una cohorte de pacientes adultos infectados con SARS-COV2 tratados con tocilizumab. Se analizó, en años de vida ganados (AVG), la media de supervivencia restringida a 1 año. Se evaluó la influencia del sexo, la edad y la gravedad en la supervivencia de los pacientes. Se calcularon el ratio coste marginal/AVG y coste marginal/superviviente. Resultados: Se incluyeron 508 pacientes (66 ± 13 años;32% mujeres). Un 17% ingresó en UCI. La supervivencia global fue del 77%. Se identificaron como factores de riesgo la edad mayor de 71,5 años (HR = 1,08;IC95% 1,07–1,10;p < 0,001), y el ingreso en UCI al iniciar el tratamiento (HR = 2,01;IC95% 1,30–3,09;p = 0,002). El impacto presupuestario total de tocilizumab en el periodo analizado ascendió a 206.466€. Los pacientes con mayor coste por unidad de resultado en salud son los pacientes ingresados en UCI y mayores de 71,5 años, que presentan un coste marginal/AVG de 966 € y un coste marginal/superviviente de 1.136€. Conclusión: La eficiencia del tratamiento con tocilizumab se asocia a la edad y a la gravedad de los pacientes. Las cifras son inferiores en todos los subgrupos a los umbrales habitualmente utilizados en las evaluaciones coste-efectividad. Los resultados del presente estudio sugieren que el inicio precoz de tocilizumab es una estrategia eficiente. Objective: To describe the marginal cost and survival of patients treated with tocilizumab in a university hospital under real-life conditions and to evaluate factors that could influence costs and health outcomes will be evaluated. Methods: Observational, single-center, retrospective study of a cohort of adult patients infected with SARS-COV2 treated with tocilizumab. The 1 year restricted mean survival time was analyzed in life-years gained (LYG). The influence of sex, age and severity on patient survival was evaluated. The marginal cost/LYG and marginal cost/survivor ratios were calculated. Results: 508 patients (66 ± 13 years;32% women) were included. Seventeen percent were admitted to the ICU. Overall survival was 77%. Age older than 71.5 years (HR = 1.08;95%CI 1.07–1.10;p < 0.001) and ICU admission at initiation of treatment (HR = 2.01;95%CI 1.30–3.09;p = 0.002) were identified as risk factors. The total budgetary impact of tocilizumab in the period analyzed was 206,466 euros. The patients with the highest cost per unit of health outcome were those admitted to the ICU and those over 71.5 years, with a marginal cost/LYG of €966 and a marginal cost/survivor of €1136. Conclusion: The efficiency of treatment with tocilizumab is associated with the age and severity of the patients. The figures are lower in all subgroups than the thresholds usually used in cost-effectiveness evaluations. The results of the present study suggest that early first dose of tocilizumab is an efficient strategy.

7.
Journal of Mazandaran University of Medical Sciences ; 32(215):163-168, 2022.
Article in Persian | EMBASE | ID: covidwho-2156500

ABSTRACT

Background and purpose: Tocilizumab (TCZ), a monoclonal antibody against interleukin-6 (IL-6) receptor, is emerged as an alternative treatment for COVID-19 patients with a risk of cytokine storms. This study aimed at investigating the efficacy of TCZ in patients with COVID-19. Material(s) and Method(s): In a retrospective observational study, we examined the demographic and clinical characteristics of patients with COVID-19 and also the outcomes of TCZ therapy (Actemra and Temziva) in Qaemshahr Razi Hospital. Result(s): Out of 56 cases, 32 (57.1%) were women and the median age of the patients was 57.5 years. Among the patients, 19 (33.9%) were admitted to ICU where seven (12.7%) were intubated and eight (14.3%) patients deceased. Before TCZ therapy, mean oxygen saturation level was 90.1% which elevated to 93.8% after receiving TCZ (P=0.001). In this study, Temziva was associated with lower mortality rate compared with Actemra (P=0.004). Conclusion(s): TCZ therapy in patients with COVID-19 could improve oxygen saturation level and Temziva results in lower mortality rate. However, further studies with larger sample size are required to confirm these results. Copyright © 2022, Mazandaran University of Medical Sciences. All rights reserved.

8.
Pakistan Journal of Medical and Health Sciences ; 16(10):182-184, 2022.
Article in English | EMBASE | ID: covidwho-2156411

ABSTRACT

Background: A hypersensitivity condition called cytokine storm is the main cause of death in COVID-19 patients. A monoclonal antibody called tocilizumab may be able to suppress the Interleukin-6 receptors (IL-6R) and lessen the likelihood that the body would have a hypersensitive immune response. Aim(s): To evaluate the mortality advantages of tocilizumab in individuals with COVID-19. Study design: Retrospective study. Place and duration of study: Bahria Town International Hospital Lahore from 16th June 2020 to 17th September 2021. Methodology: Patients with 96 confirmed instances of COVID-19 were enrolled. Two groups of patients were created. A single dosage of tocilizumab was administered to 52 participants in the first group, referred to as the survivors, and 44 patients in the second group, who passed away within 14 days. From the patients' medical records, the demographic information, co-morbid conditions, and laboratory values were obtained. The hospital's institutional review board and ethics committee (IRBEC) gave its approval for this study. The permission was ignored because this was a retroactive analysis. Result(s): 54.24 16.58 was the average age, and 54 (56.25%) of the population were men. 52 (54.16%) patients were survivors, compared to 44(45.83%) patients in the non-survivor group. In non-survivors compared to survivors, the older age group was shown to be statistically significant (62.78+/-12.86 vs. 51.65+/-11.68, p=0.003). Additionally, non-survivors had a greater BMI (p=0.006). In our study, hypertension and diabetes were the two co-morbid conditions that were most frequently detected (35.24% and 28.94%, respectively). The mortality rates among patients with diabetes, asthma, COPD, and cancer were all considerably higher (P=0.01, 0.006, and 0.004, respectively). Cancer and type-2 diabetes patients had death rates that were considerably higher (p=0.05 and p=0.01, respectively). C-reactive protein (CRP), D. Dimer, procalcitonin (PCT), and IL-6 were discovered to be the significant predictors of mortality (p 0.0001, 0.05, 0.001, and 0.004 respectively). Conclusion(s): Even though tocilizumab is authorised and has been shown to have positive results, people with diabetes, COPD, and asthma are more likely to experience negative results even after getting a single dosage of the medication. Similar to CRP, D. Dimer levels are reliable indicators of death. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

9.
Romanian Journal of Infectious Diseases ; 23(2):149-155, 2020.
Article in English | Scopus | ID: covidwho-2156245

ABSTRACT

The COVID-19 pandemic has challenged the medical world in many ways regarding diagnosis troubles and therapeutic options. In this paper, we will present three cases of patients from different age groups, in which we identified specific ways of evolution, from both clinically and laboratory data point of view. We used a critical evolution risk estimation calculator at admission and compared the results with the subsequent evolution of patients. From the analysis of the presented cases, we found persistent organic damage that will require their long-term follow-up. © 2020, Amaltea Medical Publishing House. All rights reserved.

10.
Annals of the Rheumatic Diseases ; 81(11):e214, 2022.
Article in English | MEDLINE | ID: covidwho-2152922
11.
Annals of the Rheumatic Diseases ; 81(11):e215, 2022.
Article in English | MEDLINE | ID: covidwho-2152921
12.
Annals of the Rheumatic Diseases ; 81(11):e213, 2022.
Article in English | MEDLINE | ID: covidwho-2152920
13.
Exp Ther Med ; 24(6): 724, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2143918

ABSTRACT

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic is a significant global issue that has major implications for the healthcare system. The mortality rates associated with SARS-CoV-2 infection vary according to the geographical region and are associated with age, comorbidities and vaccination status. Organ damage is caused by the cytokine release syndrome, which plays a crucial role in the course of coronavirus disease 2019 (COVID-19) infection. Innate and adaptive immune system stimulation in patients with COVID-19 results in inappropriate cytokine release. The anti-IL-6 receptor antagonist, tocilizumab, is used in the treatment of connective tissue diseases. The present single-center retrospective study on patients with COVID-19 admitted to hospital between September, 2020 and April, 2022 aimed to identify predictors of mortality and other unfavorable outcomes in patients treated with tocilizumab for COVID-19-associated pneumonia. Demographics, vaccination status against SARS-CoV-2, the Charlson comorbidity index (CCI), laboratory data and chest X-ray scores were recorded upon admission. In total, 174 subjects (121 males; mean age, 62.43±13.47 years) fulfilling the inclusion criteria were included. Among the 174 participants, 58 (33.3%) were intubated. The mortality rate was 35.1%. The non-survivors were older, mostly females, and had a higher CCI score. At the evaluation upon admission, the survivors presented with higher levels of alanine transferase and gamma glutamyl-transferase and with a greater number of platelets (PLTs), while patients that were intubated were also older, mostly females, and had a higher CCI score (P<0.05). Age was identified as the only independent factor predicting mortality in the Cox proportional hazards multivariate regression analysis. By performing a sub-analysis regarding sex, it was revealed that the value of PLTs was an independent factor predicting intubation and 90-day mortality in male patients, and the lymphocyte count was the only factor associated with intubation in female patients. On the whole, the data of the present study may be used to identify patient subpopulations responding to treatment with tocilizumab in prospective clinical trials.

14.
Front Immunol ; 13: 993720, 2022.
Article in English | MEDLINE | ID: covidwho-2142018

ABSTRACT

Pathogenesis of lung injury in COVID-19 is not completely understood, leaving gaps in understanding how current treatments modulate the course of COVID-19. Neutrophil numbers and activation state in circulation have been found to correlate with COVID-19 severity, and neutrophil extracellular traps (NETs) have been found in the lung parenchyma of patients with acute respiratory distress syndrome (ARDS) in COVID-19. Targeting the pro-inflammatory functions of neutrophils may diminish lung injury in COVID-19 and ARDS. Neutrophils were isolated from peripheral blood of healthy donors, treated ex vivo with dexamethasone, tocilizumab and intravenous immunoglobulin (IVIG) and NET formation, oxidative burst, and phagocytosis were assessed. Plasma from critically ill COVID-19 patients before and after clinical treatment with IVIG and from healthy donors was assessed for neutrophil activation-related proteins. While dexamethasone and tocilizumab did not affect PMA- and nigericin-induced NET production ex vivo, IVIG induced a dose-dependent abrogation of NET production in both activation models. IVIG also reduced PMA-elicited reactive oxygen species production, but did not alter phagocytosis. COVID-19 patients were found to have elevated levels of cell-free DNA, neutrophil elastase and IL-8 as compared to healthy controls. Levels of both cell-free DNA and neutrophil elastase were lower 5 days after 4 days of daily treatment with IVIG. The lack of impact of dexamethasone or tocilizumab on these neutrophil functions suggests that these therapeutic agents may not act through suppression of neutrophil functions, indicating that the door might still be open for the addition of a neutrophil modulator to the COVID-19 therapeutic repertoire.


Subject(s)
COVID-19 , Cell-Free Nucleic Acids , Lung Injury , Respiratory Distress Syndrome , Humans , Neutrophils/metabolism , Immunoglobulins, Intravenous/therapeutic use , Immunoglobulins, Intravenous/pharmacology , COVID-19/drug therapy , Leukocyte Elastase/metabolism , Lung Injury/metabolism , Cell-Free Nucleic Acids/metabolism , Dexamethasone
15.
Prescrire International ; 31(242):262-263, 2022.
Article in English | Scopus | ID: covidwho-2124425
16.
Asian Journal of Pharmaceutical and Clinical Research ; 15(11):121-125, 2022.
Article in English | EMBASE | ID: covidwho-2146051

ABSTRACT

Objectives: Cytokine release syndrome (CRS) is believed to be responsible for death in COVID-19. Tocilizumab is an interleukin (IL)-6 receptor antagonist, IL-6 being identified as a major component of the CRS cascade. The objective of the study was to determine if tocilizumab can prevent mortality and morbidity in moderate-to-severe COVID-19 pneumonia. Method(s): Patients admitted to the ICU between the time period of June 2020-August 2020 were included in this retrospective and cohort study conducted at GCS medical college, hospital and research center. Patients had to be more than 18 years of age and were required to have a positive reverse transcription polymerase chain reaction report for COVID-19. After applying the inclusion/exclusion criteria, 119 patients were considered for final analysis. Tocilizumab was administered as a single dose of 8 mg/kg in 22 patients. Rest of the patients received standard of care regime. The primary outcome was either discharge or death of the patients and the requirement of invasive mechanical ventilation during their hospital stay. The secondary outcome was the length of hospital stay. Appropriate demographic, clinical, and laboratory data were documented. Statistical analysis was done with appropriate clinical tests with significance set at p<0.05. Result(s): Tocilizumab significantly reduced deaths in patients as well as the need for mechanical ventilation with NNT=3 and 5, respectively. The same held true even when the data were adjusted for age, gender, and number of comorbidities. Number of comorbidities had a negative association with mortality and need for mechanical ventilation irrespective of administration of tocilizumab as evidenced by multivariable logistic regression. There was no effect of tocilizumab in shortening the hospital stay in patients. Conclusion(s): Tocilizumab seems to be a promising agent for the treatment of moderate to severe COVID-19 pneumonia and similar agents hold promise for any similar future emerging infections. Copyright © 2022 The Authors.

17.
Int J Infect Dis ; 125: 233-240, 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2131128

ABSTRACT

OBJECTIVES: Our aim was to compare outcomes of hospitalized adults with severe COVID-19 and cytokine storm treated with tocilizumab or baricitinib. METHODS: A prospective, investigational, real-world study was performed from April 2020 to April 2021 at our center. COVID-19 severity was classified by World Health Organization criteria, and cytokine storm was documented along predefined criteria. Eligible patients were enrolled at diagnosis if they fulfilled a priori inclusion criteria and received standard-of-care plus tocilizumab or baricitinib for >48 hours. Patients were followed per protocol for 28 days post-diagnosis. The primary outcome was all-cause mortality; secondary outcomes were invasive mechanical ventilation and major infectious complications. RESULTS: Of 463 patients, 102/463 (22.1%) received tocilizumab, and 361/463 (77.9%) baricitinib. Baseline characteristics were balanced. At 28 days, there was no difference in all-cause mortality (22/102, 21.6% vs 64/361, 17.7%; P-value = 0.38). Requirement for invasive mechanical ventilation was more frequent after tocilizumab (52/102, 50.9% vs 96/361, 26.6%; P <0.01), rate of major infectious complications was similar (32/102, 31.4% vs 96/361, 26.6%; P-value = 0.34). In logistic regression, the immunomodulatory drug was not retained as a predictor of all-cause mortality. Kaplan-Meier analysis revealed statistically similar survival distributions. CONCLUSION: All-cause mortality was similar between adults treated with baricitinib or tocilizumab for severe COVID-19 with cytokine storm.

18.
Health Sci Rep ; 5(6): e950, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2127742

ABSTRACT

Background and Aims: Immunosuppressive therapy has a key role in developing coronavirus disease-2019 (COVID-19)-associated mucormycosis. In this study, we investigated the effect of the type and cumulative dose of immunosuppressive agents on COVID-19-associated mucormycosis. Methods: We designed a descriptive cross-sectional study involving three COVID-19 hospitals in Iran. Clinical and demographic data were gathered from the medical records and checked by two independent researchers to minimize errors in data collection. Results: Seventy-three patients were included in the study. The mean age of cases was 57.41 (SD = 12.64) and 43.8% were female. Among patients, 20.5% were admitted to the intensive care unit (ICU) during COVID-19. Furthermore, 17 patients (23.29%) had a history of diabetes mellitus. Sixty-nine patients (94.52%) had a history of receiving corticosteroids (dexamethasone) during treatment of COVID-19, and of those, five patients (6.85%) received Tocilizumab beside. The mean cumulative dose of corticosteroids prescribed was 185.22 mg (SD = 114.738). The average cumulative dosage of tocilizumab was 720 mg (SD = 178.89). All of the included patients received amphotericin B for mucormycosis treatment, and 42 survived (57.53%). Also, there was a significant relationship between hospitalization in ICU for COVID-19 and the mucormycosis outcome (p = 0.007). However, there weren't any significant associations between cumulative doses of immunosuppressive drugs and mucormycosis outcome (p = 0.52). Conclusion: The prevalence of COVID-19-associated mucormycosis is increasing and should be considered in the treatment protocols of COVID-19. Controlling risk factors such as diabetes, malignancy and the administration of immunosuppressive agents based on recommended dosage in validated guidelines are ways to prevent mucormycosis.

19.
Pediatric Neurology ; 2022.
Article in English | ScienceDirect | ID: covidwho-2122735

ABSTRACT

Background Acute Necrotising Encephalopathy of Childhood (ANEC) is a rare para-infectious neurological disorder. It is associated with a high mortality rate and poor neurological outcomes. ANEC is postulated to arise from immune-mediated or metabolic processes driven by viral infections. While there have been some case reports of acute necrotising encephalopathy (ANE) with SARS-CoV-2 co-infection in adults, paediatric cases are rare. Case Report An 11-year-old boy with acute SARS-CoV-2 infection presented with ophthalmoplegia, ataxia and aphasia. Neuroimaging findings demonstrated significant swelling and signal changes in bilateral thalami, brainstem and cerebellar hemispheres, consistent with ANEC. His high ANEC Severity Score (ANE-SS) indicated poor neurological prognosis. Treatment with a combination of early steroid therapy, intravenous immunoglobulin (IVIG) therapy and targeted Interleukin 6 (IL-6) blockade, yielded good neurological improvements. Literature search was performed to compare and analyse similar cases of para-infectious immune-mediated encephalopathies related to SARS-CoV-2 in children. Conclusion This is the first report of a paediatric case of SARS-CoV-2 related ANEC, which responded well to early immunotherapy, including IL-6 blockade. Early immunotherapy with IL-6 blockade can be considered as an adjunct in managing severe ANEC.

20.
Infect Dis Now ; 2022 Nov 24.
Article in English | MEDLINE | ID: covidwho-2122500

ABSTRACT

OBJECTIVES: High-flow nasal cannula (HFNC) was widely used during the COVID-19 pandemic in intensive care units (ICU), but there is no recommendation for elderly patients non-eligible for ICU management. We aimed to describe the outcomes of HFNC treatment in patients with COVID-19 who are not eligible for ICU management. METHODS: Retrospective bicentric cohort study performed between September 1, 2020 and June 30, 2021 in two infectious diseases departments of Colmar Hospital and Antoine Beclere University Hospital, France. RESULTS: Sixty-four patients were treated with HFNC: 33 in Colmar and 31 in Beclere hospital (median age: 85 years; IQ, 82-92). Of these, 16 patients survived (25%). Surviving patients had a lower Charlson comorbidity index score than deceased patients (five vs six; p=0.02). CONCLUSIONS: Despite a high death rate, with survivors being younger and having fewer comorbidities, HFNC is an easy tool to implement in non-ICU wards for the frailest patients.

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