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Infection risk with the use of interleukin inhibitors in hospitalized patients with COVID-19: A narrative review.
Koritala, Thoyaja; Pattan, Vishwanath; Tirupathi, Raghavendra; Rabaan, Ali A; Al Mutair, Abbas; Alhumaid, Saad; Adhikari, Ramesh; Deepika, Keerti; Jain, Nitesh Kumar; Bansal, Vikas; Tekin, Aysun; Zec, Simon; Lal, Amos; Khan, Syed Anjum; Garces, Juan Pablo Domecq; Abu Saleh, Omar M; Surani, Salim R; Kashyap, Rahul.
  • Koritala T; Division of Hospital Internal Medicine, Mayo Clinic Health System, Mankato, USA.
  • Pattan V; Department of Endocrinology, Wyoming Medical Center, Casper, USA.
  • Tirupathi R; Department of Medicine, Keystone Health, Chambersburg, USA.
  • Rabaan AA; Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
  • Al Mutair A; Department of Public Health and Nutrition, University of Haripur, Haripur, Pakistan.
  • Alhumaid S; Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia.
  • Adhikari R; College of Nursing, Princess Norah Bint Abdulrahman University, Riyadh, Saudi Arabia.
  • Deepika K; School of Nursing, Wollongong University, Wollongong, Australia.
  • Jain NK; Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Al-Ahsa, Saudi Arabia.
  • Bansal V; Department of Hospital Medicine, Franciscan Health, Lafayette, USA.
  • Tekin A; Translational Health Disparities Science Research Program, Nemours Healthcare System for Children, Wilmington, USA.
  • Zec S; Division of Community Critical Care, Mayo Clinic Health System, Mankato, USA.
  • Lal A; Research Fellow, Mayo Clinic College of Medicine and Science, Rochester, USA.
  • Khan SA; Research Fellow, Mayo Clinic College of Medicine and Science, Rochester, USA.
  • Garces JPD; Research Fellow, Mayo Clinic College of Medicine and Science, Rochester, USA.
  • Abu Saleh OM; Critical Care Internal Medicine Fellow, Mayo Clinic College of Medicine and Science, Rochester, USA.
  • Surani SR; Division of Community Critical Care, Mayo Clinic Health System, Mankato, USA.
  • Kashyap R; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, USA.
Infez Med ; 29(4): 495-503, 2021.
Article in English | MEDLINE | ID: covidwho-1579089
ABSTRACT

INTRODUCTION:

To date, only corticosteroids and interleukin-6 (IL-6) inhibitors have been shown to reduce mortality of hospitalized patients with COVID-19. In this literature review, we aimed to summarize infection risk of IL inhibitors, with or without the use of corticosteroids, used to treat hospitalized patients with COVID-19.

METHODS:

A literature search was conducted using the following evidence-based medicine reviews Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Embase; Ovid Medline; and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions 1946 to April 28, 2021. All relevant articles were identified using the search terms COVID-19 or SARS-coronavirus-2, infections, interleukins, inpatients, adults, and i ncidence.

RESULTS:

We identified 36 studies of which 2 were meta-analyses, 5 were randomized controlled trials, 9 were prospective studies, and 20 were retrospective studies. When anakinra was compared with control, 2 studies reported an increased risk of infection, and 3 studies reported a similar or decreased incidence of infection. Canakinumab had a lower associated incidence of infection compared with placebo in one study. When sarilumab was compared with placebo, one study reported an increased risk of infection. Nine studies comparing tocilizumab with placebo reported decreased or no difference in infection risk (odds ratio [OR] for the studies ranged from 0.39-1.21). Fourteen studies comparing tocilizumab with placebo reported an increased risk of infection, ranging from 9.1% to 63.0% (OR for the studies ranged from 1.85-5.04). Infection most commonly presented as bacteremia. Of the 6 studies comparing tocilizumab and corticosteroid use with placebo, 4 reported a nonsignificant increase toward corticosteroids being associated with bacterial infections (OR ranged from 2.76-3.8), and 2 studies reported no increased association with a higher infection risk.

CONCLUSIONS:

Our literature review showed mixed results with variable significance for the association of IL-6 inhibitors with risk of infections in patients with COVID-19.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Language: English Journal: Infez Med Journal subject: Allergy and Immunology Year: 2021 Document Type: Article Affiliation country: Liim-2904-1

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Language: English Journal: Infez Med Journal subject: Allergy and Immunology Year: 2021 Document Type: Article Affiliation country: Liim-2904-1