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Comparison of CPFA and Tocilizumab Treatments in Cytokine Release Syndrome Developing in Covid-19 Disease

Year 2021, Volume: 18 Issue: 2, 311 - 317, 27.08.2021
https://doi.org/10.35440/hutfd.915967

Abstract

Project Number

Yok

References

  • Referans1 Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506.
  • Referans2 https://coronavirus.jhu.edu/map.html (Son erişim: 07.04.2021)
  • Referans3 Zaim S, Chong JH, Sankaranarayanan V and Harky A. COVID-19 and Multiorgan Response. Curr Probl Cardiol. 2020 Apr 28 : 100618.
  • Referans4 Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ; HLH across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-4.
  • Referans5 Bajema KL, Oster AM, McGovern OL, Lindstrom S, Stenger MR, Anderson TC, et al. Persons Evaluated for 2019 Novel Coronavirus- United States, January 2020. MMWR Morb Mortal Wkly Rep 2020; 69(6): 166-70.
  • Referans6 Panagiotou A, Gaiao S, Cruz ND. Extracorporeal therapies in sepsis. Journal of Intensive Care Medicine, 2013, 28.5: 281-95.
  • Referans7 Cesano G, Livigni S, Vallero A, Olivieri C, Borca M, Quarello F, et al. Treatment of septic shock with the use of CPFA (associated plasma filtration and adsorption): impact on hemodynamics monitored with PiCCO. G Ital Nefrol 2002; 20:258–63.
  • Referans8 Davies R, Choy E. Clinical experience of IL-6 blockade in rheumatic diseases—implications on IL-6 biology and disease pathogenesis. In: Seminars in immunology. Academic Press, 2014. p. 97-104.
  • Referans9 Wolf J, Rose-John S, Garbers C. Interleukin-6 and its receptors: a highly regulated and dynamic system. Cytokine, 2014, 70.1: 11-20.
  • Referans10 Jones SA, Scheller J, Rose-John S. Therapeutic strategies for the clinical blockade of IL-6/gp130 signaling. The Journal of clinical investigation, 2011, 121.9: 3375-83.
  • Referans11 Kaly L, Rosner I. Tosilizumab–A novel therapy for non-organ-specific autoimmune diseases. Best practice & research Clinical rheumatology, 2012, 26.1: 157-65.
  • Referans12 Yokota S, Imagawa T, Mori M, Miyamae T, Aihara Y, Takei S, et al. Efficacy and safety of Tosilizumab in patients with systemic-onset juvenile idiopathic arthritis: a randomised, double-blind, placebo-controlled, withdrawal phase III trial. The Lancet, 2008, 371.9617: 998-1006.
  • Referans13 Gabay C, Emery P, Vollenhoven Rv, Dikranian A, Alten R, Pavelka K, et al. Tosilizumab monotherapy versus adalimumab monotherapy for treatment of rheumatoid arthritis (ADACTA): a randomised, double-blind, controlled phase 4 trial. The Lancet, 2013, 381.9877: 1541-50.
  • Referans14 Grupp SA , Kalos M , Barrett D , Aplenc R , Porter DL , Rheingold SR , et al. Chimeric antigen receptor-modified T cells for acute lymphoid leukemia. N Engl J Med 2013;368:1509–18 .
  • Referans15 Winkler U , Jensen M , Manzke O , Schulz H , Diehl V , Engert A . Cytokine-release syndrome in patients with B-cell chronic lymphocytic leukemia and high Lymphocyte counts after treatment with an anti-CD20 monoclonal antibody (rituximab, IDEC-C2B8). Blood 1999;94:2217–24 .
  • Referans16 Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet respiratory medicine. 2020;8(4):420–2.
  • Referans17 Shimizu M. Clinical features of cytokine storm syndrome. In: Cron R, Behrens E. editors. Cytokine Storm Syndrome. Cham: Springer; (2019). 31–42.
  • Referans18 Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of autoimmunity, 2020, 109: 102433.
  • Referans19 Yao Q, Wang P, Wang X, Qie G, Meng M, Tong X, et al. A retrospective study of risk factors for severe acute respiratory syndrome coronavirus 2 infections in hospitalized adult patients. Pol Arch Intern Med. 2020; 130 (5): 390-9.
  • Referans20 Peschel G, Jung EM, Fisser C, Putz FJ, Werteheimer T, Sinner B, et al. Interstitial lung opacities in patients with severe COVID-19 pneumonia by bedside high-resolution ultrasound in association to CO 2 retention. Clinical Hemorheology and Microcirculation, 2020, Preprint: 1-11.
  • Referans21 Kang S, Tanaka T, Narazaki M, Kishimoto T. Targeting interleukin-6 signaling in clinic. Immunity, 2019, 50.4: 1007-23.
  • Referans22 Pang QL, He WC, Li JX, Huang L. Symptomatic and optimal supportive care of critical COVID-19: A case report and literature review. World journal of clinical cases, 2020, 8.23: 6181.
  • Referans23 McCreary EK, Jason MP. Coronavirus disease 2019 treatment: a review of early and emerging options. In: Open forum infectious diseases. US: Oxford University Press, 2020. p. ofaa105.
  • Referans24 Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clinical infectious diseases, 2020, 71.15: 762-8.
  • Referans25 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine, 2020, 382.18: 1708-1720.journal of medicine 382.18 (2020): 1708-20.
  • Referans26 Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. The Lancet infectious diseases 20.4 (2020): 425-34.
  • Referans27 Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Rui H, et al. Discovery of a novel coronavirus associated with the recent pneumonia outbreak in humans and its potential bat origin. BioRxiv (2020).
  • Referans28 Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020; 1- 34
  • Referans29 Villar J, Blanco J, Campo Rd, Ojeda DA, Dominguez FJD, Muriel A, et al. Assessment of PaO2/FiO2 for stratification of patients with moderate and severe acute respiratory distress syndrome. BMJ open, 2015, 5.3.
  • Referans30 Villar J , Perez-Mendez L, Blanco J, Anon JM, Blanch L, Belda J, et al. A universal definition of ARDS: the PaO 2/FiO 2 ratio under a standard ventilatory setting—a prospective, multicenter validation study. Intensive care medicine, 2013, 39.4: 583-92.
  • Referans31 Khwannimit B, Bhurayanontachai R, Vattanavit V. Comparison of the accuracy of three early warning scores with SOFA score for predicting mortality in adult sepsis and septic shock patients admitted to intensive care unit. Heart & Lung, 2019, 48.3: 240-244.
  • Referans32 Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754-8.
  • Referans33 Zhang C, Wu Z, Li JW, Zhao H, Wang GQ. The cytokine release syndrome (CRS) of severe COVID-19 and Interleukin-6 receptor (IL- 6R) antagonist Tocilizumab may be the key to reduce the mortality. Int J Antimicrob Agents. (2020) 29:105954.
  • Referans34 Coomes EA, Haghbayan H. Interleukin‐6 in COVID‐19: a systematic review and meta‐analysis. Reviews in medical virology, 2020, 30.6: 1-9.
  • Referans35 Han H, Ma Q, Li C, Liu R, Zhao L, Wang W, et al. Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors. Emerg Microbes Infect 2020;9:1123-30.
  • Referans36 Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive care medicine, 2020, 46.5: 846-8.

Covid-19 Hastalığında Gelişen Sitokin Salınım Sendromunda CPFA ve Tosilizumab Tedavilerinin Karşılaştırılması

Year 2021, Volume: 18 Issue: 2, 311 - 317, 27.08.2021
https://doi.org/10.35440/hutfd.915967

Abstract

Amaç
İlk olarak Aralık 2019’da Çin’in Wuhan kentinde ortaya çıkan ve Dünya Sağlık Örgütü tarafından SARS-CoV-2 olarak adlandırılan yeni koronavirüs, Covid-19 hastalığına neden oldu ve küresel ölçekte bir pandemi başlattı. Başlangıçta hipoksik solunum yetmezliği ile kendini gösteren hastalık, vücuttaki tüm sistemleri de etkileyerek multiorgan yetmezliğine ve ölüme sebebiyet veren progresif bir gelişim gösterdi. Özellikle şiddetli progresyon gösteren Covid-19 olgularında kontrolsüz sitokin üretimi gözlenmekte ve bu durumun artmış mortalitenin nedenlerinden biri olduğu düşünülmektedir.
Covid-19 hastalığı nedeniyle yoğun bakımımızda yatmakta olan ve SARS-CoV-2 virüsünün tetiklediği kontrolsüz sitokin üretimi sonrası sitokin salınım sendromu ve/veya sitokin fırtınası geliştiğini düşündüğümüz hastalara Coupled Plasma Filtration Adsorption(CPFA) ve Tosilizumab tedavileri uyguladık. Çalışmamızda bu tedavilerin etkinliklerini, geriye dönük dosya ve arşiv taraması üzerinden değerlendirmeyi amaçladık.
Materyal ve Metod
Çalışmamızın etik kurul onayı, Sağlık Bilimleri Üniversitesi Hamidiye Klinik Araştırmalar Etik Kurulu’ndan 17/06/2020-18521 sayılı yazı ile alınmıştır. Çalışmamıza Covid-19 hastalığı sebebiyle Şubat-Haziran 2020 tarihleri arasında yoğun bakım ünitemizde yatmış, sitokin salınım sendromu ve/veya sitokin fırtınası geliştiği düşünülmüş ve tedavi amacıyla CPFA veya Tosilizumab uygulanmış hastalar dahil edildi. Çalışmamız her tedavi grubundan 20’şer hastanın verileri retrospektif olarak taranarak planlandı.
CPFA uygulamaları, her seans 10 saat olacak şekilde ve 12 saat ara verilmek suretiyle 2 seans olarak yapılmıştır. Tosilizumab uygulaması 8 mg/kg dozdan, maksimum 800 mg olacak şekilde, 1 saatlik sürede intravenöz yoldan yapılmıştır.
CPFA ve Tosilizumab uygulamaları başlamadan hemen önce, uygulamalar sonrası 24. saat, 48. saat ve 7. gün ölçülen ve hesaplanan SOFA skorları, Horowitz index değerleri (PaO2/FiO2), ateş değerleri, inotrop varlığı, SpO2 ve ilgili birtakım laboratuvar değerleri(IL-6, Lenfosit sayısı, CRP, D-dimer) dosyalarından ve sistemsel verilerden temin edildi.
Bulgular
CPFA ve Tosilizumab tedavileri sonrası ateş ve IL-6 değerlerinde düşme, SpO2 ve lenfosit değerlerinde artış, Horowitz ve SOFA skorlarında artış, CRP ve D dimer değerlerinde azalma izlenmiştir. SpO2 ve Horowitz skoru değerlerinde artış CPFA grubunda anlamlı olarak daha yüksekti. 7. günün sonunda ateş değerlerinde düşme ve SOFA skorlarında artış ile CRP - D dimer değerlerinde düşme CPFA grubunda anlamlı olarak daha belirgindi. İnotrop desteğinde azalma CPFA grubunda izlendi.
Sonuç
Covid-19 hastalığında bağışıklık sisteminin etkilenmesi sonrası gelişen sitokin salınım sendromu ve/veya sitokin fırtınası ile hastalık daha ağır seyretmektedir. CPFA ve Tosilizumab tedavileri ile inflamatuar sitokin üretimi kontrol altına alınarak, hastaların oksijenizasyonunda ve klinik bulgularında düzelmeler sağlanmıştır.

Supporting Institution

Yok

Project Number

Yok

References

  • Referans1 Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506.
  • Referans2 https://coronavirus.jhu.edu/map.html (Son erişim: 07.04.2021)
  • Referans3 Zaim S, Chong JH, Sankaranarayanan V and Harky A. COVID-19 and Multiorgan Response. Curr Probl Cardiol. 2020 Apr 28 : 100618.
  • Referans4 Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ; HLH across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-4.
  • Referans5 Bajema KL, Oster AM, McGovern OL, Lindstrom S, Stenger MR, Anderson TC, et al. Persons Evaluated for 2019 Novel Coronavirus- United States, January 2020. MMWR Morb Mortal Wkly Rep 2020; 69(6): 166-70.
  • Referans6 Panagiotou A, Gaiao S, Cruz ND. Extracorporeal therapies in sepsis. Journal of Intensive Care Medicine, 2013, 28.5: 281-95.
  • Referans7 Cesano G, Livigni S, Vallero A, Olivieri C, Borca M, Quarello F, et al. Treatment of septic shock with the use of CPFA (associated plasma filtration and adsorption): impact on hemodynamics monitored with PiCCO. G Ital Nefrol 2002; 20:258–63.
  • Referans8 Davies R, Choy E. Clinical experience of IL-6 blockade in rheumatic diseases—implications on IL-6 biology and disease pathogenesis. In: Seminars in immunology. Academic Press, 2014. p. 97-104.
  • Referans9 Wolf J, Rose-John S, Garbers C. Interleukin-6 and its receptors: a highly regulated and dynamic system. Cytokine, 2014, 70.1: 11-20.
  • Referans10 Jones SA, Scheller J, Rose-John S. Therapeutic strategies for the clinical blockade of IL-6/gp130 signaling. The Journal of clinical investigation, 2011, 121.9: 3375-83.
  • Referans11 Kaly L, Rosner I. Tosilizumab–A novel therapy for non-organ-specific autoimmune diseases. Best practice & research Clinical rheumatology, 2012, 26.1: 157-65.
  • Referans12 Yokota S, Imagawa T, Mori M, Miyamae T, Aihara Y, Takei S, et al. Efficacy and safety of Tosilizumab in patients with systemic-onset juvenile idiopathic arthritis: a randomised, double-blind, placebo-controlled, withdrawal phase III trial. The Lancet, 2008, 371.9617: 998-1006.
  • Referans13 Gabay C, Emery P, Vollenhoven Rv, Dikranian A, Alten R, Pavelka K, et al. Tosilizumab monotherapy versus adalimumab monotherapy for treatment of rheumatoid arthritis (ADACTA): a randomised, double-blind, controlled phase 4 trial. The Lancet, 2013, 381.9877: 1541-50.
  • Referans14 Grupp SA , Kalos M , Barrett D , Aplenc R , Porter DL , Rheingold SR , et al. Chimeric antigen receptor-modified T cells for acute lymphoid leukemia. N Engl J Med 2013;368:1509–18 .
  • Referans15 Winkler U , Jensen M , Manzke O , Schulz H , Diehl V , Engert A . Cytokine-release syndrome in patients with B-cell chronic lymphocytic leukemia and high Lymphocyte counts after treatment with an anti-CD20 monoclonal antibody (rituximab, IDEC-C2B8). Blood 1999;94:2217–24 .
  • Referans16 Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet respiratory medicine. 2020;8(4):420–2.
  • Referans17 Shimizu M. Clinical features of cytokine storm syndrome. In: Cron R, Behrens E. editors. Cytokine Storm Syndrome. Cham: Springer; (2019). 31–42.
  • Referans18 Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of autoimmunity, 2020, 109: 102433.
  • Referans19 Yao Q, Wang P, Wang X, Qie G, Meng M, Tong X, et al. A retrospective study of risk factors for severe acute respiratory syndrome coronavirus 2 infections in hospitalized adult patients. Pol Arch Intern Med. 2020; 130 (5): 390-9.
  • Referans20 Peschel G, Jung EM, Fisser C, Putz FJ, Werteheimer T, Sinner B, et al. Interstitial lung opacities in patients with severe COVID-19 pneumonia by bedside high-resolution ultrasound in association to CO 2 retention. Clinical Hemorheology and Microcirculation, 2020, Preprint: 1-11.
  • Referans21 Kang S, Tanaka T, Narazaki M, Kishimoto T. Targeting interleukin-6 signaling in clinic. Immunity, 2019, 50.4: 1007-23.
  • Referans22 Pang QL, He WC, Li JX, Huang L. Symptomatic and optimal supportive care of critical COVID-19: A case report and literature review. World journal of clinical cases, 2020, 8.23: 6181.
  • Referans23 McCreary EK, Jason MP. Coronavirus disease 2019 treatment: a review of early and emerging options. In: Open forum infectious diseases. US: Oxford University Press, 2020. p. ofaa105.
  • Referans24 Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clinical infectious diseases, 2020, 71.15: 762-8.
  • Referans25 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine, 2020, 382.18: 1708-1720.journal of medicine 382.18 (2020): 1708-20.
  • Referans26 Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. The Lancet infectious diseases 20.4 (2020): 425-34.
  • Referans27 Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Rui H, et al. Discovery of a novel coronavirus associated with the recent pneumonia outbreak in humans and its potential bat origin. BioRxiv (2020).
  • Referans28 Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020; 1- 34
  • Referans29 Villar J, Blanco J, Campo Rd, Ojeda DA, Dominguez FJD, Muriel A, et al. Assessment of PaO2/FiO2 for stratification of patients with moderate and severe acute respiratory distress syndrome. BMJ open, 2015, 5.3.
  • Referans30 Villar J , Perez-Mendez L, Blanco J, Anon JM, Blanch L, Belda J, et al. A universal definition of ARDS: the PaO 2/FiO 2 ratio under a standard ventilatory setting—a prospective, multicenter validation study. Intensive care medicine, 2013, 39.4: 583-92.
  • Referans31 Khwannimit B, Bhurayanontachai R, Vattanavit V. Comparison of the accuracy of three early warning scores with SOFA score for predicting mortality in adult sepsis and septic shock patients admitted to intensive care unit. Heart & Lung, 2019, 48.3: 240-244.
  • Referans32 Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754-8.
  • Referans33 Zhang C, Wu Z, Li JW, Zhao H, Wang GQ. The cytokine release syndrome (CRS) of severe COVID-19 and Interleukin-6 receptor (IL- 6R) antagonist Tocilizumab may be the key to reduce the mortality. Int J Antimicrob Agents. (2020) 29:105954.
  • Referans34 Coomes EA, Haghbayan H. Interleukin‐6 in COVID‐19: a systematic review and meta‐analysis. Reviews in medical virology, 2020, 30.6: 1-9.
  • Referans35 Han H, Ma Q, Li C, Liu R, Zhao L, Wang W, et al. Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors. Emerg Microbes Infect 2020;9:1123-30.
  • Referans36 Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive care medicine, 2020, 46.5: 846-8.
There are 36 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Tuna Ertürk 0000-0002-6092-3291

Bülent Barış Güven 0000-0002-3628-7408

Caner Ediz 0000-0001-9717-1209

Sevgi Kesici 0000-0002-8276-6039

Aysin Ersoy 0000-0002-1575-1603

Project Number Yok
Publication Date August 27, 2021
Submission Date April 15, 2021
Acceptance Date July 7, 2021
Published in Issue Year 2021 Volume: 18 Issue: 2

Cite

Vancouver Ertürk T, Güven BB, Ediz C, Kesici S, Ersoy A. Covid-19 Hastalığında Gelişen Sitokin Salınım Sendromunda CPFA ve Tosilizumab Tedavilerinin Karşılaştırılması. Harran Üniversitesi Tıp Fakültesi Dergisi. 2021;18(2):311-7.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty