RESUMO
Background: Tocilizumab and anakinra are anti-interleukin drugs to treat severe coronavirus disease 2019 (COVID-19) refractory to corticosteroids. However, no studies compared the efficacy of tocilizumab versus anakinra to guide the choice of the therapy in clinical practice. We aimed to compare the outcomes of COVID-19 patients treated with tocilizumab or anakinra. Methods: Our retrospective study was conducted in three French university hospitals between February 2021 and February 2022 and included all the consecutive hospitalized patients with a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection assessed by RT-PCR who were treated with tocilizumab or anakinra. A propensity score matching was performed to minimize confounding effects due to the non-random allocation. Results: Among 235 patients (mean age, 72 years; 60.9% of male patients), the 28-day mortality (29.4% vs. 31.2%, p = 0.76), the in-hospital mortality (31.7% vs. 33.0%, p = 0.83), the high-flow oxygen requirement (17.5% vs. 18.3%, p = 0.86), the intensive care unit admission rate (30.8% vs. 22.2%, p = 0.30), and the mechanical ventilation rate (15.4% vs. 11.1%, p = 0.50) were similar in patients receiving tocilizumab and those receiving anakinra. After propensity score matching, the 28-day mortality (29.1% vs. 30.4%, p = 1) and the rate of high-flow oxygen requirement (10.1% vs. 21.5%, p = 0.081) did not differ between patients receiving tocilizumab or anakinra. Secondary infection rates were similar between the tocilizumab and anakinra groups (6.3% vs. 9.2%, p = 0.44). Conclusion: Our study showed comparable efficacy and safety profiles of tocilizumab and anakinra to treat severe COVID-19.
Assuntos
COVID-19 , Humanos , Masculino , Idoso , SARS-CoV-2 , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Pontuação de Propensão , Estudos Retrospectivos , Tratamento Farmacológico da COVID-19 , OxigênioRESUMO
Multi-elemental imaging of soft tissues using Laser-induced breakdown spectroscopy, also known as LIBS, allows for the direct visualization of the distribution of endogenous or exogenous elements within tissues. LIBS was used to image the kinetics of metal nanoparticles in elimination organs, but also the physiological distribution of biological elements in situ and the topography of chemicals or metals in exposed human tissues. Based on our experience and recent literature in the field of imaging the elemental content of animal and human specimens, this review describes the principle and characteristics of the instrument, technical considerations for setting up experiments with LIBS, its advantages, limitations and possibilities for pre-clinical and medical applications.
TITLE: L'imagerie élémentaire par spectroscopie LIBS - De nouvelles applications en médecine. ABSTRACT: L'imagerie multi-élémentaire des tissus biologiques grâce à la spectroscopie LIBS (laser-induced breakdown spectroscopy) permet la visualisation directe de la distribution des éléments endogènes ou exogènes. Cette technologie est notamment utilisée pour mettre en image la cinétique des nanoparticules métalliques dans les organes d'élimination, mais également pour analyser la distribution physiologique des éléments biologiques in situ, et pour révéler la topographie des éléments chimiques, comme les métaux, dans des tissus humains qui ont été exposés à des agents extérieurs potentiellement toxiques. Fondée sur notre expérience et les travaux les plus récents dans le domaine de l'imagerie du contenu élémentaire des tissus animaux et humains, cette revue décrit les principes et les caractéristiques de l'instrumentation LIBS, présente certains aspects techniques pour mettre en place des expériences avec cet outil, montre les avantages et les limites de cette technologie, et s'intéresse aux différentes possibilités qu'offre l'imagerie LIBS pour des applications précliniques et médicales.
